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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes sphincter incontinence, collapse and repetitive speech?

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Dr. Rahul Tawde

General & Family Physician

Practicing since :1980

Answered : 1 Question

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Posted on Wed, 20 Aug 2014 in Digestion and Bowels
Question: My sister in law suddenly collapsed 4 days ago at home, her bowels went loose everywhere, she had been feeling tired all day , she had a sudden high fever and uncontrollable shaking ( probabaly a Rigor ...I a am Nurse ) . She is in hospital in the UK on a saline drip and IV antibiotics , her blood cultures have not coe back yet her fever is now up and down and less severe, she is agitated and still unsteady on her feet and repeat's her words. Recently she started taking Thyroxine for an under active Thyroid. She also has Coeliac disease . She had a brain tumour when she was young she is now 40. Had a CT scan but is showed nothing. No one sees to know what is wrong with her. They are think of taking her to another hospital for a deeper scan ? MRI, what would they be looking for please
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Answered by Dr. Rahul Tawde 1 hour later
Brief Answer:
MRI is needed to exclude stroke

Detailed Answer:
Hi,
Thanks for posting your concern in the HCM.

The symptoms of your sister-in-law raise the suspicion of a cerebrovascular accident, commonly called stroke. Sphincter incontinence, collapse, altered gait and repetitive speech may all be due to that.

By doing the CT scan her doctors have excluded the possibility of an acute haemorrhage. As it came out to be normal, they now want to exclude any ischaemia or loss of blood supply or some minute haemorrhage or a TIA (mini stroke) or any other brain pathology that cannot be detected by a CT scan. And I can assure you that it is a very rational way of treating a patient with such symptoms.
The work up they have done so far including blood tests and imaging are very logical and as per treatment protocols.

They have tested for infection or sepsis, started most probably with broad spectrum empirical antibiotic treatment, have been maintaining hydration and electrolyte balance and are looking for any underlying cause. MRI is part of that investigation protocol.
So, don't worry.

If you are satisfied with my answer please close the thread and rate my answer. If you have any queries, please write back.
Regards,
Dr. Kaushik
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Follow up: Dr. Rahul Tawde 4 hours later
Hi, they have just said they think she has a kidney infection, but they are heavily sedating her to stop her tremors and pacing around the ward , confusion and agitation. she has no loin pain. this doesn't make sense to me. Now no head scan
doctor
Answered by Dr. Rahul Tawde 1 hour later
Brief Answer:
Focus of infection is kidney

Detailed Answer:
Thanks for prompt reply.
From the information provided I can say that the doctors thought that the focus of infection is kidney. When we find that a patient has fever, we think of underlying infection or inflammation. Then we do blood count test to determine whether it is due to some bacteria or virus or something other than infection. When we are confirmed that there is infection, we try to find out the source or focus. In this case the doctors suspect an infection or inflammation of kidney. So, they did scan and found no abnormality. But, as in case of brain, when we do scan or imaging of any part of body, different imaging tests can determine abnormalities of different tissue types. So when they found out no abnormality in CT they want to visualise other tissue types by doing MRI.
Secondly, if they are doing so, they must have clinically excluded a stroke and that is possible. But, still they saw that there were neurological signs. So, the question was- why was it like that? So, perhaps they suspected metabolic encephalopathy from sepsis. And the only way to treat that is to treat the infection. And again to do that identification of the primary focus or source is necessary.
Thirdly, renal or urinary tract infections can present with fever with chill and rigors and metabolic encephalopathy without a loin pain.
So, please don't worry. I could only give you the probable justification from the available information. But, you can ask your doctor too. And we the doctors are bound to clarify every details, because we are at your service. So, please don't hesitate until you are satisfied.
If you have any queries, please write back. Or else, if you are satisfied, please close the thread and rate my answer.
Regards,
Dr. Kaushik
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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