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Hi, I Am 39 Years Old Female. With History Of
Question: hi, i am 39 years old female. with history of type 2 diabetes for past 15 years, on janument -50/1000 and Amaryl, I take medication for Hypertension since past 4years. I had a mild stroke last year August. I have occulsion in right MCA. it was at 85% in dec 2019 and when i did an MRA in March 2020 it showed complete occulsion with collatorals formed. I have been on Clopidorgel, Atrova, diabetic medication, BP Medication, Concorco 2.5mg, since last year. Cardiac risk was ruled out after usual check ups. some of the doctors are suggesting stent and others are saying it is not needed. I have questions on how does this progress?what to expect next?what to take care of? Since the time i had the stroke i have been regular with 1-1.5 hrs of cardio workout and diet. my HBA1c is 6.5 and cholestorle is 67, BP has always been normal ranges. Will collatoral help /replace the support the main artery was provding? i can give more details if needed. till now no one has been able to find the reason for the stroke. I had 8.0 HBA1C when i had the stroke last year
hi, i am 39 years old female. with history of type 2 diabetes for past 15 years, on janument -50/1000 and Amaryl, I take medication for Hypertension since past 4years. I had a mild stroke last year August. I have occulsion in right MCA. it was at 85% in dec 2019 and when i did an MRA in March 2020 it showed complete occulsion with collatorals formed. I have been on Clopidorgel, Atrova, diabetic medication, BP Medication, Concorco 2.5mg, since last year. Cardiac risk was ruled out after usual check ups. some of the doctors are suggesting stent and others are saying it is not needed. I have questions on how does this progress?what to expect next?what to take care of? Since the time i had the stroke i have been regular with 1-1.5 hrs of cardio workout and diet. my HBA1c is 6.5 and cholestorle is 67, BP has always been normal ranges. Will collatoral help /replace the support the main artery was provding? i can give more details if needed. till now no one has been able to find the reason for the stroke. I had 8.0 HBA1C when i had the stroke last year
Brief Answer:
DSA would help in further decision making.
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 clinical and MRI/MRA details of last year as well as this year's.
Diabetes and hypertension are well known risk factors for brain stroke. In such cases, antiplatelets and statins are sufficient for preventing stroke recurrence (you are already on these medicines). In addition, strict BP and sugar control are needed, which you are already doing.
Regarding stenting, it is not needed, if there is 100% stenosis. For stent to be successful, the blockage should be less than 100%. Sometimes, MR Angiogram reports are not accurate. The gold standard is DSA- digital subtraction angiography of cerebral vessels, which would give clearer picture regarding three things- 1. Whether the occlusion is 100% or less, 2. Whether there are adequate collaterals, 3. To rule out cerebral vasculitis.
In young strokes, we need to exclude vasculitis as a cause of stroke, where DSA can help. This is more important, as a clear-cut cause has not identified for your stroke (except for sugar and BP).
I sincerely hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
DSA would help in further decision making.
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 clinical and MRI/MRA details of last year as well as this year's.
Diabetes and hypertension are well known risk factors for brain stroke. In such cases, antiplatelets and statins are sufficient for preventing stroke recurrence (you are already on these medicines). In addition, strict BP and sugar control are needed, which you are already doing.
Regarding stenting, it is not needed, if there is 100% stenosis. For stent to be successful, the blockage should be less than 100%. Sometimes, MR Angiogram reports are not accurate. The gold standard is DSA- digital subtraction angiography of cerebral vessels, which would give clearer picture regarding three things- 1. Whether the occlusion is 100% or less, 2. Whether there are adequate collaterals, 3. To rule out cerebral vasculitis.
In young strokes, we need to exclude vasculitis as a cause of stroke, where DSA can help. This is more important, as a clear-cut cause has not identified for your stroke (except for sugar and BP).
I sincerely hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
DSA would help in further decision making.
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 clinical and MRI/MRA details of last year as well as this year's.
Diabetes and hypertension are well known risk factors for brain stroke. In such cases, antiplatelets and statins are sufficient for preventing stroke recurrence (you are already on these medicines). In addition, strict BP and sugar control are needed, which you are already doing.
Regarding stenting, it is not needed, if there is 100% stenosis. For stent to be successful, the blockage should be less than 100%. Sometimes, MR Angiogram reports are not accurate. The gold standard is DSA- digital subtraction angiography of cerebral vessels, which would give clearer picture regarding three things- 1. Whether the occlusion is 100% or less, 2. Whether there are adequate collaterals, 3. To rule out cerebral vasculitis.
In young strokes, we need to exclude vasculitis as a cause of stroke, where DSA can help. This is more important, as a clear-cut cause has not identified for your stroke (except for sugar and BP).
I sincerely hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
DSA would help in further decision making.
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 clinical and MRI/MRA details of last year as well as this year's.
Diabetes and hypertension are well known risk factors for brain stroke. In such cases, antiplatelets and statins are sufficient for preventing stroke recurrence (you are already on these medicines). In addition, strict BP and sugar control are needed, which you are already doing.
Regarding stenting, it is not needed, if there is 100% stenosis. For stent to be successful, the blockage should be less than 100%. Sometimes, MR Angiogram reports are not accurate. The gold standard is DSA- digital subtraction angiography of cerebral vessels, which would give clearer picture regarding three things- 1. Whether the occlusion is 100% or less, 2. Whether there are adequate collaterals, 3. To rule out cerebral vasculitis.
In young strokes, we need to exclude vasculitis as a cause of stroke, where DSA can help. This is more important, as a clear-cut cause has not identified for your stroke (except for sugar and BP).
I sincerely hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
The earlier the better.
Detailed Answer:
Thank you for getting back.
COVID is a much minor illness, as compared to brain stroke. All over the world, people are advised not to delay management of stroke due to COVID pandemic. This is because stroke is disabling as well as fatal in some cases. I would advise against delaying DSA.
DSA is a safe procedure and it carries a risk of only 1-4% in good centers.
Regarding the future progression and treatment, it would be clear only after DSA. Any more advice (compared to what I gave last time) is not possible at this time.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
The earlier the better.
Detailed Answer:
Thank you for getting back.
COVID is a much minor illness, as compared to brain stroke. All over the world, people are advised not to delay management of stroke due to COVID pandemic. This is because stroke is disabling as well as fatal in some cases. I would advise against delaying DSA.
DSA is a safe procedure and it carries a risk of only 1-4% in good centers.
Regarding the future progression and treatment, it would be clear only after DSA. Any more advice (compared to what I gave last time) is not possible at this time.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
The earlier the better.
Detailed Answer:
Thank you for getting back.
COVID is a much minor illness, as compared to brain stroke. All over the world, people are advised not to delay management of stroke due to COVID pandemic. This is because stroke is disabling as well as fatal in some cases. I would advise against delaying DSA.
DSA is a safe procedure and it carries a risk of only 1-4% in good centers.
Regarding the future progression and treatment, it would be clear only after DSA. Any more advice (compared to what I gave last time) is not possible at this time.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
The earlier the better.
Detailed Answer:
Thank you for getting back.
COVID is a much minor illness, as compared to brain stroke. All over the world, people are advised not to delay management of stroke due to COVID pandemic. This is because stroke is disabling as well as fatal in some cases. I would advise against delaying DSA.
DSA is a safe procedure and it carries a risk of only 1-4% in good centers.
Regarding the future progression and treatment, it would be clear only after DSA. Any more advice (compared to what I gave last time) is not possible at this time.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
thank you so much for the detailed explanation and suggestion for further investigation. I was supposed to travel to my native in April for further follow up check,however due to the covid this has been delayed. Since you suggested DSA, which was suppoed to be done in May, i was not able to do it till now. My cousin who is a doctor (neuro) in XXXXXXX suggests that i travel only once things settle down as the COVID cases in XXXXXXX and very high right now. Since i stay all by myself in XXXXXXX it is a little difficult to get this test done if it requires someone to be there with me. However, since it has been couple of months since we know there is complete occlusion, i want to know if this is very critical to be done right away, else i will wait till Sept to travel to XXXXXXX to get this done.
Also, I would like to know the complications related to this procedure and in patients like me what is the progression of this condition and what is the usual course of treatment and recovery/management.
If there is complete occlusion will i still be able to go on with my normal life and acitivites with the collatorals that are formed, or will it require some kind of intervention or procedure.
thank you in advance for your support.
thank you so much for the detailed explanation and suggestion for further investigation. I was supposed to travel to my native in April for further follow up check,however due to the covid this has been delayed. Since you suggested DSA, which was suppoed to be done in May, i was not able to do it till now. My cousin who is a doctor (neuro) in XXXXXXX suggests that i travel only once things settle down as the COVID cases in XXXXXXX and very high right now. Since i stay all by myself in XXXXXXX it is a little difficult to get this test done if it requires someone to be there with me. However, since it has been couple of months since we know there is complete occlusion, i want to know if this is very critical to be done right away, else i will wait till Sept to travel to XXXXXXX to get this done.
Also, I would like to know the complications related to this procedure and in patients like me what is the progression of this condition and what is the usual course of treatment and recovery/management.
If there is complete occlusion will i still be able to go on with my normal life and acitivites with the collatorals that are formed, or will it require some kind of intervention or procedure.
thank you in advance for your support.
Dear Doctor,
thank you so much for the detailed explanation and suggestion for further investigation. I was supposed to travel to my native in April for further follow up check,however due to the covid this has been delayed. Since you suggested DSA, which was suppoed to be done in May, i was not able to do it till now. My cousin who is a doctor (neuro) in XXXXXXX suggests that i travel only once things settle down as the COVID cases in XXXXXXX and very high right now. Since i stay all by myself in XXXXXXX it is a little difficult to get this test done if it requires someone to be there with me. However, since it has been couple of months since we know there is complete occlusion, i want to know if this is very critical to be done right away, else i will wait till Sept to travel to XXXXXXX to get this done.
Also, I would like to know the complications related to this procedure and in patients like me what is the progression of this condition and what is the usual course of treatment and recovery/management.
If there is complete occlusion will i still be able to go on with my normal life and acitivites with the collatorals that are formed, or will it require some kind of intervention or procedure.
thank you in advance for your support.
thank you so much for the detailed explanation and suggestion for further investigation. I was supposed to travel to my native in April for further follow up check,however due to the covid this has been delayed. Since you suggested DSA, which was suppoed to be done in May, i was not able to do it till now. My cousin who is a doctor (neuro) in XXXXXXX suggests that i travel only once things settle down as the COVID cases in XXXXXXX and very high right now. Since i stay all by myself in XXXXXXX it is a little difficult to get this test done if it requires someone to be there with me. However, since it has been couple of months since we know there is complete occlusion, i want to know if this is very critical to be done right away, else i will wait till Sept to travel to XXXXXXX to get this done.
Also, I would like to know the complications related to this procedure and in patients like me what is the progression of this condition and what is the usual course of treatment and recovery/management.
If there is complete occlusion will i still be able to go on with my normal life and acitivites with the collatorals that are formed, or will it require some kind of intervention or procedure.
thank you in advance for your support.
Brief Answer:
It is an invasive procedure.
Detailed Answer:
They inject a XXXXXXX via a catheter. So, it is an invasive procedure. However, it is a well established procedure, it is routinely done and it is quite safe.
Let me know the reports of DSA, after you get it done.
Best wishes,
Dr Sudhir Kumar MD DM
It is an invasive procedure.
Detailed Answer:
They inject a XXXXXXX via a catheter. So, it is an invasive procedure. However, it is a well established procedure, it is routinely done and it is quite safe.
Let me know the reports of DSA, after you get it done.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
It is an invasive procedure.
Detailed Answer:
They inject a XXXXXXX via a catheter. So, it is an invasive procedure. However, it is a well established procedure, it is routinely done and it is quite safe.
Let me know the reports of DSA, after you get it done.
Best wishes,
Dr Sudhir Kumar MD DM
It is an invasive procedure.
Detailed Answer:
They inject a XXXXXXX via a catheter. So, it is an invasive procedure. However, it is a well established procedure, it is routinely done and it is quite safe.
Let me know the reports of DSA, after you get it done.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sure doctor, I will do it as soon as possible. Is this an invasive procedure?
Do they inject the XXXXXXX or is it with a catheter and do it ?
Do they inject the XXXXXXX or is it with a catheter and do it ?
Sure doctor, I will do it as soon as possible. Is this an invasive procedure?
Do they inject the XXXXXXX or is it with a catheter and do it ?
Do they inject the XXXXXXX or is it with a catheter and do it ?
Brief Answer:
Best wishes.
Detailed Answer:
Best wishes,
Dr Sudhir Kumar MD DM
Best wishes.
Detailed Answer:
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Best wishes.
Detailed Answer:
Best wishes,
Dr Sudhir Kumar MD DM
Best wishes.
Detailed Answer:
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sure doctor. I will share the reports once I get it done.
Thank you for your timely advice and support.
Best regards
Nandini
Thank you for your timely advice and support.
Best regards
Nandini
Sure doctor. I will share the reports once I get it done.
Thank you for your timely advice and support.
Best regards
Nandini
Thank you for your timely advice and support.
Best regards
Nandini
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