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What Do These Following Lab Reports Indicate?

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Posted on Mon, 24 Oct 2016
Question: My father who was suffering from psychiatric(Dr XXXXXXX Chabra Psychiatric Metro hospital) problems from last 2-3 years suddenly lost vision. We consulted Dr RP XXXXXXX (Visitech centre) and he suggested MRI for it. We have got MRI done and found some problems in brain. We consulted neurologist first in Vimhans and he suggested some medicines (N Sairam Prescription) attached after one we week we suggested another neurologist LK Malhotra (Max) prescription attached. He suggested some tests ( all Reports attached). We couldn't do MRA brain with neck as suggested by Dr Malhotra because patient was having cough and couldn't lie properly on MRI machine even after sedation. My father also having psychiatric problems so it is becoming difficult to control stroke and psychiatric problem together.
Right now my father is on Dr LK Malhotra medicines along with (Oleanz 2.5 and Zapiz .5) medicines as prescribed Dr XXXXXXX Chabra (Psychiatric).
Please have a look at the prescription and suggest if ongoing treatment is good or what better we can do.

We also got Echocardiography done and report was fine for it as well.
doctor
Answered by Dr. Sudhir Kumar (28 minutes later)
Brief Answer:
Treatment is going on along correct lines.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted your father's clinical details and also seen his reports/prescriptions.

He has suffered a brain stroke, and the medicines prescribed by Dr Malhotra are correct. He needs to continue PREVA (clopidogrel) and COLTRO (rosuvastatin) to prevent any strokes in future. Nootropil (piracetam) helps improve the speech. Telma (Telmisartan) is a good medicine to control the blood pressure.

In addition, physiotherapy and speech therapy should be continued for better recovery.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sudhir Kumar (1 hour later)
Thanks for replying back sir.
My father has become very aggressive since yesterday. He is not sleeping properly even though we are giving him (Oleanz 2.5 and Zapiz .5) medicines as prescribed Dr XXXXXXX Chabra (Psychiatric).

He is very aggressive lately and not having peaceful sleeps(sleep disorder sometimes doesn't sleep for around two days).. He is just trying to roam around in apartment and speaking very loudly.

After looking at the MRI, would you recommend any other test?
Since you are saying medicines prescribed by Dr Malhotra are to prevent further strokes would you recommend any treatment for recovery?

I was reading about IV rtPA(tissue plasminogen activator) treatment online however I am not sure whether this treatment is applicable in my father case or not. Please suggest.

Thanks a lot Sir for such a quick reply. I am relieved now.

I will consult psychiatric tomorrow for sleep disturbance and agitation problem.

One more thing, Dr Malhotra also prescribed MRA Angiography (Brain and neck) that we couldn't do. We have tried to get MRA brain with neck 4 times at different diagnostic centre using sedation and tried without sedation as well but because he starts coughing at the time of MRA and technicians unable to do analysis and couldn't complete the tests.

Please let me know the importance of MRA tests and how urgently these should be done? Will there be any adverse impact of delay ? Or how beneficial this test actually is.
doctor
Answered by Dr. Sudhir Kumar (14 minutes later)
Brief Answer:
Psychiatry review is needed.

Detailed Answer:
Thank you for getting back with more information.

For aggressive behaviour, sleep disturbance and agitation, he needs to review with Psychiatrist to adjust the medicines.

No further tests are needed, as all essential tests have been done.

Recovery would happen with physiotherapy, and no medicines are needed for that.

IV rt-PA is given in the first four and half hours after the onset of brain stroke, and is not recommended after that.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)


Brief Answer:
Carotid doppler can be done instead.

Detailed Answer:
Thank you for getting back.

Angiography is needed to look for any significant narrowing of brain and neck arteries. MR angiography is ideal, however, it needs patient's full cooperation. If MRA is not possible, he can undergo carotid doppler test, which is much simpler and can be easily done. Carotid doppler can provide important information about neck arteries supplying blood to brain.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 6232 Questions

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What Do These Following Lab Reports Indicate?

Brief Answer: Treatment is going on along correct lines. Detailed Answer: Hi, Thank you for posting your query. I am Dr Sudhir Kumar, Neurologist, and would try my best to help you. I have noted your father's clinical details and also seen his reports/prescriptions. He has suffered a brain stroke, and the medicines prescribed by Dr Malhotra are correct. He needs to continue PREVA (clopidogrel) and COLTRO (rosuvastatin) to prevent any strokes in future. Nootropil (piracetam) helps improve the speech. Telma (Telmisartan) is a good medicine to control the blood pressure. In addition, physiotherapy and speech therapy should be continued for better recovery. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, XXXXXXX XXXXXXX Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in