Medical Case: What else needs to be done?
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What else needs to be done? (Neurology)

Dr. Afifa Nighat., FCPS IMM

 

Medical Case Details:

78 year old male , k/c HTN , DM (borderline ) ,, History of fall 10 days back now presented with complain of headaches.Patient was admitted and managed on the lines of Headache .CT brain showed Age related changes.Cardiology consult was also done.Patients clinical condition improved during the stay.Now discharged in stable condition with given medications

 


    Discussions


    Dr. Mustafa Ibrahim Abdelaziz Emara
    Psychiatrist

    I think he needs to do some investigations such as; Kidney function tests and a full examination of his eyes every year.

    27.Sep, 06:03pm

    Dr. Rahul Pramod Patil
    Neuro Surgeon

    Hi I think this patient of yours need to have a follow up every 15days for 2 months, or if his complaints get worse.
    There are few things in this patients we are worried about.
    1) old patients with history of DM and HT , are generally on blood thinner ( aspirin or clopidogrel), due to atropic nature of brain, these patients are prone for development of sub-acute or chronic SDH (due to slow intracranial bleed). This patients may present with increasing intensity or frequency of headache, difficulty in walking, incontinence, forgetfulness , focal neurological deficit, vomiting, drowsiness/ sleepiness, blurring of vision. So a follow-up scan is required. ( I prefer a follow-up MRI brain with MRA brain and neck).
    2) this patient are also prone for age related ischemic changes or bleed ( secondary to HT) in brain. So I prefer to do a follow up scan with MRI with MRA brain ( as CT brain is the best scan for acute bleed but does not give reliable details is about other problems of brain).
    3) mild headache is seen in 33% of patients even if the CT scan is normal ( in all age group), this headache may or may not respond to analgesic. Reassurance to the patient is very important in this cases along with proper follow-up. Patient need to be explained about the warning signs of raised ICT.
    4) complete work up of DM and HT need to be done.

    ▲ 2
    28.Sep, 12:07pm



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