What is the prognosis for a mild brain stroke in an elderly patient?

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Posted on Tue, 21 Nov 2017 in Brain and Spine
Question: Question for my Father, who is 70 years. - Question on Mild Brain stroke
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Answered by Dr. Dariush Saghafi 25 minutes later
Brief Answer:
Your father needs higher level of care than what he is getting

Detailed Answer:
Good evening. It certainly does sound as if an evolving stroke is a reasonable explanation to your father's symptoms. If, however, there is improvement then, what should be done is he should be transferred to a hospital with at least a NEUROINTENSIVE CARE UNIT where he can be monitored and where they have expertise in stroke and how it can complicate.

He should also be in a place capable of working his heart, neck, and other metabolic aspects up using more sophisticated equipment, scans, and lab testing in order to PREVENT his getting worse. They should try and determine the origin or underlying cause of the blood clot. It was from the heart or carotid arteries then, a determination needs to be made whether or not your father should be on anticoagulation vs. an antiplatelet drug such as PLAVIX or AGGRENOX....or even just plain aspirin.

The fact that he's getting better in about 1 day is an encouraging sign but it is possible he can go the other direction and get worse. About 15-20% of patients will get worse over a time interval of 1-3 weeks following stroke after a brief improvement. This is why he should be in a higher level of care setting so that he can be adequately and quickly worked up to discover the cause and then, the doctors will know the best way to prevent another episode from happening again.

Please rate this encounter highly with some kind words of feedback if I've allowed you to understand some additional aspects of your father's presentation and what should be done to optimally treat him and write me at: www.bit.ly/drdariushsaghafi for further questions/comments.

Time to answer and investigate case is 15 minutes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 7 minutes later
Thanks Doctor.. for your valuable answers.

I attached the reports, Can you please look at the attached CT-Scan report and let me know your thoughts/Suggestions ?

Thanks
Sxxxxxx
doctor
Answered by Dr. Dariush Saghafi 11 hours later
Brief Answer:
Extremely difficult to see any detail in those scans- Here's what he needs

Detailed Answer:
Thank you for trying to provide additional information, however, the views of the CT scan in the way you are holding them is not sufficient for it to be easily read for the type of detail necessary to tell exactly what might be going on. If you can get a hold of CD ROM disk which most hospitals will provide along with the scanned images then, those could be potentially uploaded into a DROPBOX file and sent to my attention.

What I can definitely say about the scan under full magnification of my system is that I do not see any evidence of significant amounts of any blood, tumors, vascular malformations, nor aneurysms. I do not see any significant shift or compression of the midline structures, however, it is also obvious that your father is rotated in the scanner and NOT symmetric with respect to his head oritentation to the scanning element. This makes it impossible to compare one side of the brain to the other which is necessary in order to diagnose swelling, compression, or bleeding. A CT is generally obtained in these types of cases in order to rule out those types of things on a rather LARGE or GROSS basis but generally is not a sufficiently sensitive study in order to localize where a blood clot got stuck or what the extent of damage is likely to be as far as the image is concerned. Also, it is not possible to control a patient's head position as we see in this example whereas in an MRI in fact, you can have control over that variable to some extent.

In order to do the best studies possible for your father here is what is needed:

1. MRI of the brain
2. MRA of the head and neck
3. Diffusion/Perfusion weighted imaging sequences (stroke protocol)

He DOES NOT need any type of IV contrast for these assessments and I would avoid them unless you know for sure he has very solid and healthy kidneys. Event then, I would not get the XXXXXXX contrast because it is simply unnecessary.

If no MRI capability is present at this hospital or facility then, a REPEAT CT scan should be performed in the next 24 hrs. along with a CTA of the head and neck to the aortic arch. They should try and instruct him to stay still with his head in the scanner or do something to block the head from moving side to side.

If you have copies of the REPORTS that were read along with the scanned images then, this would be most helpful for me to interpret unless you can upload digital images directly from a CD ROM.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 38 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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