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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for neck arthritis

Answered by
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3143 Questions

Posted on Wed, 25 Apr 2018 in Brain and Spine
Question: This is a question about my mother, age 93. Mom has bad neck arthritis. No surgery. She had some injections in the neck and upper cervical, including occipital nerve block 4 weeks ago. The shots didnt seem to help much.
For the last 3 weeks, she has had episodes that last from 2 to 5 hours-----almost daily--- " groggy" and "foggy" head feeling where she had trouble saying all her words, weak feeling, sleepy , headache from back of neck to top of head..., still some neck pain. This starts always when she is on her feet. Not when sleeping.
We went to ER. CT of head 10 days ago was negative. Blood work was ok. MRI of head 2 days ago was ok except for age related changes. These episodes come and go--- not permanant. Once its over, she talks and thinks normal. The neurologist is thinking TIA . But not sure. Mom has had a few of those tia but rarely over the last few years. This daily occurrance is new.
She has earlier been diagnosed with AFIB (7 years ago-- controlled)... CHF.....her meds are----She takes plavix 75,...(used to take warfarin but some falls resulted in change to plavix-- for safety)........800 Multaq ....50 metoprolol blood pressure .... 90 nifedipine blood pressure...25 hctz..... she has one kidney.
please give me your thoughts on what her problem is
Answered by Dr. Erion Spaho 3 hours later
Brief Answer:
Postural hypotension and carotids stenosis to consider besides TIA.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

If your mother was my patient, I would consider three possible diagnoses:

1. TIA

2. Stenosis (atherosclerosis ) of the carotid arteries

3. Postural hypotension.

An ultrasound of the neck vessels is necessary as a first step to evaluate any vascular stenosis.

Monitoring of the blood pressure in laying, sitting and standing position for a couple of days is necessary to evaluate postural hypotension.

Discuss with your mother's Doctor about getting evaluated further in these directions.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
Follow up: Dr. Erion Spaho 12 hours later
Doctor they did the blood pressure tests....sit, stand and lay down.... and the carotid was ok.... and the CT and MRI of head were ok.... Doctor
can you have TIA and have it not show up on ct or mri??? Her symptoms come and go... not constant. Also mom has dehydration... would that cause this ?????
Answered by Dr. Erion Spaho 16 hours later
Brief Answer:
Dehydration is a possibility.

Detailed Answer:
Welcome back and thanks for being on follow up.

TIA should be confirmed by MRI imaging especially on the diffusion weighted sequences.

So, if there were no signs of ischemic changes in MRI, TIA is unlikely the diagnosis.

The answer to your second question is yes, dehydration and related electrolytes levels changes may cause such issues.

Hope this helps.

Take care.
Above answer was peer-reviewed by : Dr. Raju A.T

The User accepted the expert's answer

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