Suggest treatment for neurofibromatosis in an elderly person

Posted on Tue, 21 Feb 2017 in Brain and Spine
Question: My aunt is 77 years old. She has Neurofibromatosis since she was a child with no effect on her functions. She lately started to forget many day to day details arbitrarily.. sometimes very alert and sometimes not. She broke her thie hinge and had to go thru the operation of fixing a cemented hinge. Now she practices little movement training yet with ZERO apetite and thus very little food.. she started to talk none sence and we hot a local Neurologist who ordered the tests attached. He connected her to Ringer solution to control the Sodium and Potassium levels until the analysis results are received. Now I received them and attach them hereto wanting your assessment
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Several changes.

Detailed Answer:
I read your question carefully and I understand your concern.

Those results are worrying. They show a deterioration in her kidney function, marked anemia as well as a very high platelet count. Her potassium levels also are high. I think she should be admitted because further tests are needed to determine the source of these alterations. I think bone marrow aspiration as well as imaging of her abdomen for possibility of a tumor will be needed. In my opinion an internal medicine ward is the most appropriate place to continue the diagnostic process and treatment.

As for the issue with her memory.....while I think the changes in the tests require more urgent attention, I believe brain imaging would be advisable as well. That is because first that raised platelet count may lead to brain lesions such as stroke. The other reason is that neurofibromatosis patients have a higher risk for brain tumors, so that a change in their neurological status should prompt a brain imaging exam.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 56 minutes later
She had a brain CT before the bone operation 2 weeks ago and it was clear. The sudden change is that she never eats.. and ALMOST sleeps lesser than 2 hours a day.
Can you secure the Internal Medicine advice or I have to readdress the case to them from scrach?
Answered by Dr. Olsi Taka 53 minutes later
Brief Answer:
Read below

Detailed Answer:
The fact that she has had a brain CT 2 weeks ago is reassuring at least regarding the brain tumor possibility. If the symptoms were already present then it is reassuring regarding a stroke as well. It would seem that the brain is suffering not due to a primary brain lesion but due to the alteration of her general state.

I am afraid I can't help you regarding internal medicine as I am only a member such as you with the only additional privilege of being able to answer questions as I am a doctor. Also I mentioned internal medicine as I thought many diagnostic tests were needed, they had to be done in a hospital setting, can't be done online.
However you didn't mention that the surgery was only 2 weeks ago. That does change things a little, because the alterations may be due to the fracture and surgical procedure with the blood loss leading to anemia and the raised platelet count may be due to her bone marrow reacting to this blood loss, increasing its activity. It doesn't necessarily have to be a tumor or other blood conditions. In that scenario more time is needed to restore previous balance and simply supportive treatment through hydration and feeding, correction of electrolyte abnormalities may be helpful. However that is hard to say based only on one test result, one (including an internist colleague) would need prior test results to compare and see the evolution in time. Also when dealing with kidney function and electrolyte abnormalities such as in this case one can't have a fixed therapy and leave it at that, regular repeat tests in order to monitor evolution and adapt therapy are needed. That is why I still think she should be followed by an internist but in a hospital setting as repeat blood tests and variations in therapy may be needed.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Olsi Taka


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