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.
28.Sep, 12:07pm