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Dr. Andrew Rynne

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What causes a prolong unconsciousness and does the treatment for awakening such patient suspected to succumbed a stroke be same as that for seizure?

Answered by
Dr.
Dr. Ajay Panwar

Neurologist

Practicing since :2007

Answered : 1795 Questions

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Posted on Wed, 9 Jan 2019 in Brain and Spine
Question: Hello doctor,
Unfortunately, my mother in law, 85, had an episode four days ago, after which she gradually, but partially lost consciousness. By the time she went to hospital, she could only communicate minimally with doctors and family, and lost control of her bodily functions.
Scans of her brain did not indicate ischemic stroke signs, but the possibility that a stroke might have still occurred deep in the brain stem, although not visible on scans, was not excluded.
She is being kept under surveillance at ICU for the last two days, and has been put on blood thinning and other medications for the last two days, and her vital indicators are stable/normal.
What could be her chances of regaining consciousness and recovery?

Maybe it would also help to mention that several times in the last two years, she has had similar short episodes, where she regained consciousness at home after only a few minutes. Doctors have not been able to tell for sure whether these were actually caused by a stroke or a seizure.

In case the cause for the loss of consciousness this time was not a stroke, could that have been one or more epileptic seizure/s from which she could have not recovered easily, because of her weakened general condition (was having a flu as well)?

In the case of a seizure, would the same medicine/procedures work towards her awakening/regaining consciousness, or will it still be necessary to administer something suitable for seizures (diazepam, lorazepam etc)?

Many thanks!
doctor
Answered by Dr. Ajay Panwar 3 hours later
Brief Answer:

Medicines will be different for seizures and stroke

Detailed Answer:

Hi,

Single seizure would not cause prolonged impairment of consciousness as in her case, however, multiple seizures can cause so.

So, stroke may have been considered as a more probable diagnosis. Was MRI of brain done? Stroke in most cases will appear on MRI. EEG will also help to look for any seizure discharges in the brain.

Lastly, blood abnormalities like sugar, electrolytes, kidney and liver function tests may result in impaired consciousness and should be screened for.

No, the medicines are different for seizures and stroke.

Hope that helps. If you have any further questions,I shall be glad to have you in follow-up.

Regards,

Dr.Ajay Panwar,
Neurologist

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ajay Panwar 2 hours later
Many thanks doctor!

Two scans of the brain were performed (not an MRI as far as I know, and not sure if EEG or something different), and those showed no signs of new stroke (only some signs of old but very minor ones). Stroke was considered however, as a more probable diagnosis, assuming that any clot/damage could be located deep in the brain stem, and considering her partially unconscious condition.

Blood tests were performed, sugar, electrolytes and bacterial/viral, but no problem was found. Also no problem with the heart. As regards kidney, some problem/dysfunction was found, believed to have been caused two days ago, when they injected her with a XXXXXXX for lung screening/scanning.

Seizures were excluded as a diagnosis by the doctors, as they believed those did not sufficiently justify her condition (It appears to me however, that several seizures probably could). Therefore, no seizure medication has been administered so far. Can that still be done?
Currently, she can minimally communicate, move eyes, recognize voices, feel pain, but appears to be in a sleeping state most of the time and is currently under treatment in ICU.

I have also heard of several drugs (Zolpidem/Ambien, Amantadine, Lorazepam), that could help a patient in a partially unconscious state, awake, even after a stroke. Could such drugs be given to the patient in this case?

I have also sent a file of the brain scan of my mother in law made a few days ago at the hospital, which I hope can help.

Looking forward to receiving an answer from you soon.

Many thanks and best regards,
Ana
doctor
Answered by Dr. Ajay Panwar 14 hours later
Brief Answer:

Images are not adequate to comment on diagnosis.

Detailed Answer:

Hi,

Thanks for being in follow-up.

I have gone through the images which you have uploaded;however, the images show the basal sections only and it is hard to comment on the diagnosis just on the basis of these images.

I would appreciate if you can upload the report or the main film provided by the imaging centre.

The drugs like Zolpidem/Ambien, Amantadine, Lorazepam have no rationale to be given in such a scenario and nor is there any basis, that these should help in recovering consciousness after stroke.

Hope that helps. If you have any further questions,I shall be glad to have you in follow-up.

Regards

Dr.Ajay Panwar,
Neurologist

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ajay Panwar 47 minutes later
Thank you again doctor!
This was the maximum of messages I could upload here in the website. However, I could send you the images/film files via email message. Could you please give me your email address?
Best regards,
Ana
doctor
Answered by Dr. Ajay Panwar 10 minutes later
Brief Answer:
Ask the support staff to send me the attachments as mail.

Detailed Answer:

Hi,

Thanks for being in follow-up.

In order to send me the attachments as mail to YYYY@YYYY , with sub ATTN DR XXXXXXX PANWAR.

Hope that helps. I shall be glad to have you in follow-up.

Regards,

Dr Ajay Panwar,
Neurologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 1 hour later
Two emails with attachments have just been sent to the email indicated.
The film is too large to be sent as an email attachment.
Hope you find these adequate.
Thank you.
doctor
Answered by Dr. Ajay Panwar 2 hours later
Brief Answer

Brain atrophy, old ischemic lesions

Detailed Answer:

Hi,

Thanks for being in follow-up.

I've gone through your email attachments. CT shows brain atrophy(likely age related)and old small ischemic lesions(old infarct).

No clear brain stem infarct is apparent, however, CT may often miss the small lesions and MRI is required to rule out the stroke.

Hope that helps. If you have any further questions,I shall be glad to have you in follow-up.

Regards,

Dr. Ajay Panwar,
Neurologist

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ajay Panwar 25 hours later
Thank you doctor! How old could these lesions be? In which area of the brain are they located and what body functions were they likely to have impaired?
doctor
Answered by Dr. Ajay Panwar 20 hours later
Brief Answer:
Ganglio-capsular region

Detailed Answer:

Hi,

Thanks for being in follow-up.

Old lacunar lesion is visible in a ganglio-capsular region which is unlikely to cause unconsciousness.

Hope that helps. If you have any further questions, I shall be glad to have you in follow-up.

Regards,

Dr. Ajay Panwar
Neurologist

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ajay Panwar 4 hours later
Thank you!
What in your view could have more probably caused the unconsciousness?
Best regards,
Ana
doctor
Answered by Dr. Ajay Panwar 12 hours later
Brief Answer:

MRI Brain would be a better test

Detailed Answer:

Hi,

Thanks for being in follow-up.

With a CT, its hard to comment on a fresh stroke many times; an MRI is required in such a case. An MRI may pick up other abnormal signal intensities also which may guide towards the diagnosis.

As of now, as I have not seen the patient, I can’t conclusively say about the cause of unconsciousness.

Hope I have answered your query.

Regards,

Dr. Ajay Panwar
Neurologist
Above answer was peer-reviewed by : Dr. Kampana
doctor
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