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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What cause unconsciousness and paralysis followed by a major fall?

Answered by
Dr. Arnab Banerjee

Critical Care Specialist

Practicing since :2012

Answered : 1290 Questions

Posted on Tue, 7 Jun 2016 in Accident and Emergency
Question: My niece's fiancée arrived in Southeast Asia with parents. His mother said he fell on the bathroom floor and went unconscious. He had taken numerous medication. She said she gave him percaset and codeine before. He laid unconscious for three hours before she called an ambulance. During that time she said she tried to wait him up by pouring Red Bull in his mouth. He arrived at hospital unconscious, had a stroke or paralysis on left side. He has been in and out of consciousness. He has been on dialysis with kidney failure. He cannot speak. He was moved out of ICU for two days and two days ago went back into ICU. He presents himself currently (by mothers account) as being unconscious for 3 days, back on dialysis, losing a lot of fluid and has had a temperature of 105 degrees for 48 hours. We believe our niece should fly to Singapore asap due to his condition. Mother has history of physical abuse. Hospital and US Embassy will not talk with a non-relative of patient. What is your diagnosis with information that we have. Also, he had a seizure about six months ago and we suspect substance abuse in the form of pills for many years. Please direct us in our research with his condition. We believe he is near death our niece should leave immediately to see him since she does not have access to any information other then the untrustworthy mother of her fiancée. Concerned....
Answered by Dr. Arnab Banerjee 57 minutes later
Brief Answer:
several possibilities can be there..

Detailed Answer:
Hello XXXX , Welcome to HCM,

I've gone through your query and understand your concern..

Yes , things are definitely quite critical for him at this moment..

Now there are several factors involved here, let me get them one by one , along with several questions also, which i'd request you to go through and try to answer them as many as possible for a better clarity of the situation and off course a proper diagnosis as close as possible.. request you take your time while answering cause these are complicated medical issues, which are all inter-related, so I'll try to present them as simple as possible _

1. No human being can be left 'completely' unconscious for three hours specially after the kind of fall you've explained and regained consciousness , yes like you've said , there must be underlying Drug overdose involved in that..

2. Now I can understand that she must've been super-anxious at that time , but trying to pour Red-Bull in the mouth of an unconscious person can only worsen his situation as it can obstruct his airway and causing severe cardio-respiratory damage up to cerebral damage to the extent of mortality.. so that way he was quite lucky to got away with that..

3. Yes , stroke involving certain area of brain can definitely cause paralysis (please note that paralysis is the after effect of the damage should not be confused with the disease itself )..

4. Now comes the most tricky and doubtful part in this - the 'Unconsciousness' - which can be there due to several causes in his case i.e. first and foremost is the head-injury due to fall (which will cause Bleeding in side the brain but not stroke , both are different entity) -

So please recheck if you mean Stroke or ICH (Intra Cerabral Hemorrhage or even Contusion) ?

Secondly , it can be due to drug overdose also, which can be detected with immediate Toxicology screening test run by the hospital , so try to find that out as lot of drugs have several deleterious effects on body's organ systems..

Thirdly, Was he previously suffering from any Kidney disease or did the hospital run the Dialysis to filter the blood from toxins - both are different and sometimes can even be combined, but you need to specifically find it out as survival and patient outcomes depend on them..

I'm stressing more on it because, later on in your question, you've mentioned that 'He's back on dialysis, loosing a lot of fluid' , so please try to find it out as Dialysis can be done for both the purposes..

Next thing is , further deterioration can be there due to several causes i.e. infection Specially hospital acquired in his case as it seems he's there for quite a while, recurrence of any brain hemorrhage or swelling in side the brain, meningitis, sepsis, severe kidney failure, toxin overload to say just a few....

Seizure is a very nonspecific symptom in this case, it can be there due to withdrawal effects of several drugs/alcohol , electrolyte imbalance, chronic kidney disease or any underlying undetected pathology which might've been there for quite a while..

Fever of such high grade can be there due to frank-Sepsis, Intra Cerebral bleed(Central) , or any drug-fever - there's just these few differential diagnosis..

Now at this point of time , what could've been really helpful if you can get any CASE SUMMARY of him issued by the hospital (they do that in every part of the world, you can simply ask for it as it contains the complete details of his presenting 'exact' condition along with a Full Course of Treatment and investigations done so far, along with past and present physical findings ) , which can provide lot of clarity from your side and save all those energy for researches and let you concentrate on his well being..

You can simply tell them to e-mail you the Case-Summary so that you can have a detailed look at it, also it'll give me a definite status about him to narrow down what exactly is going on as well as if he can make it or not ....

I still don't think that you should loose hope , specially when they're just so young , but one thing is for sure that your Niece must leave 'Now' to her fiancee than to repent for ever.. hard truth of life.. please ensure that she leaves right away before it's too late..

Please keep me updated, try to dig those informative documentations out as they can be of immense help that you can even imagine of..

My Best wishes..
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

The User accepted the expert's answer

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