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Q. My mother is restless, and has hallucinations and a small bump on her head. What to do?

Answered by
Dr. Ravi M Soni
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Sep 02, 2020

This is on behalf of my mother, aged 82. She does not have sugar, BO, or cholestrol, and takes food normally. Four years ago, she underwent a major surgery SLEEVE RESECTION for GIST in the stomach. The operation was a success and the tumour was removed. The post operative pathology report showed some traces of not-so-malignant Carcinoma. The surgeon sent her to the a Regional Cancer Center for review. The RCC advised her to take tablet IMITAB for one and a half years. After that she is visiting the RCC for periodic checks once in three months. Nothing unusual has been found so far.

Now my mother is experiencing certain other problems. She is restless always. She never lies down or sleep in daytime. During night she is very reluctant to lie down or sleep. She walks all night and talks to persons who are not present as if in a hallucination. The Doctor said it can be early dementia and has advised an evaluation to R/o infracramel pathology O/E hyperpigmentation generalised.

For the past couple of days her restlessness and hallucinative visions and talk increased alarmingly. She even started climbing the windows at night. We shall be much obliged to you if you please recommend some medication to control these behaviour temporarily till the test is taken and regular treatment started?

Dr. Ravi M Soni

Geriatrics Psychiatry Psychologist/ Counsellor Sexology

hi... sorry for the delay... according to your explanation of the symptoms... to me it is more like delirium due to some underlying pathology..she is 82 yrs old.. so already her memory has been weaken by ageing...i dont know about her cognition and memory... whether she is able to identify and recognize family members.?..particularly when there is hallucination, restlessness and agitation... whether she talks to persons that are not present? her sleep wake cycle has been reversed?..whether she tries to search something in bed, picking clothes and bedsheets? whether she sees insects and snakes in surrounding?... i dont know but if these are present then delirium is confirmed...u shud go for routine investigations like... serum Na,K,Ca..s.urea, s.creat, HB, total leucocyte count, RBS, URINE ROUTINE AND MICROSCOPIC EXAMINATION AND ALSO CULTURE SENSITIVITY REPORT.... keep that in mind that constipation also causes delirium in old age...and why there is delay in investigation? u shud go for investigation for intracranial pathology as soon as possible....u shud go for CT SCAN HEAD PLAIN OR MRI BRAIN .... these both will help... MRI is preffered...first of all u shud gof or routine checkup i have just mentioned...then for imaging... u can give her tablet Qutan 25-50 mg at night for her behavior disturbance... but unless u identify her pathology it wont resolve completely...

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Dear Dr. Ravi Sony, Your advices have been very valuable. I am greatly astonished at the exactness of your listing of my mother’s other symptoms that I haven’t narrated to you! You are one of the best physicians I have come across. It is true that she has severe constipation! She has good prescience and she has somehow discovered cure for constipation all by herself – she insists on eating plantain fruits everyday and I happily give her at least 6 fruits everyday without fail. She also asks for several glasses of hot water, preparatory to her emptying of bowls. Believe me, these two treatments have never been advised by any medical man! Unfortunately she empties her bowels on alternate days only. Now that you named constipation as one of the reasons for delirium, I remember that days on which she has free and complete discharge from bowels, her disturbances are relatively mild.
Your listing of symptoms for delirium perfectly matches my mother – always she searches for something in the bed, under the bed, on the floor, on the shelves. She wont allow a bedsheet or pillow remain in their place. She carries them with her as she leaves the bed. Often she picks some small unseen objects from her other palm and eats them! She picks floor mats and misplces them. Fortunately, she sees no insects and snakes. She goes in front of the full-length mirrors and makes guestures at her own reflection and talks to it. She had never failed to recognize a family friend, or acquintances. Her memory of the remote past is excellent. She recognizes and remembers political leaders on the TV. Even when she is having a delirium, restlessness or agitation, she returns to normalcy immediately when she is accosted or addressed by someone. She sees and talks to persons who are not present. Sometimes she goes on weeping for hours for no apparent reason at all. She hates to remain quiet. She will not lie down on the bed even if she drops her head in drowsiness.
She has also developed over the years some small semi-spherical projections of 1 cm radius and about 0.5 cm height, on the head just above the forehead.
Could you please enlighten me on the following:
1. How is intracranial pathology done, I mean, how is the bioptic sample collected? Does it involve incision or penetration of any kind into the head? The doctor advised us to do the intracranial pathology at the RCC, hence the delay. Can it be done reliably at private laborateries? Does it require hospitalisation?
2. Please give me a detailed prescription for all the necessary tests, including one for intracranial pathology.
3. Could you please prescribe some harmless medicines for constipation, for continued use?
It would be very kind of you if you provide an early and detailed advice.

Dr. Ravi M Soni

Geriatrics Psychiatry Psychologist/ Counsellor Sexology
# what RCC people are suspecting?..means if they are suspecting any malignancy then follow their advice... and I feel that before going for biopsy they should have done non invasive investigations like MRI BRAIN WITH CONTRAST... this is their field of expertise...I dont know.. u have not mentioned about radio-imaging investigations...the biopsy procedure depends upon the suspected site of possible tumor or any malignancy in brain...depending on that there are different ways of approaching that...but biopsy do include invasive procedures like making hole in skull...passing the probe...some biopsies can be done through base of the skull... and they are less invasive procedures...that can be done only by experts....whether it is private or govt...neurosurgeons and onco-surgeons... with the help of live radio-imaging during the procedure...for anaesthetic preparations it requires hospitalization and can be discharged on the same day.....
keep that in mind that if there is any malignancy is there... then all these symptoms may be becoz of that...i already given the list of inveatigations... that will suffice....and for investigations for intracranial pathology...i ve already given two investigations....and further is the field of expertise of cancer people....
for leafy vegetables...fruits... some activity like walking....engaging her in some activity...shud not be bed ridden whole day,,...u can give her syrup duphalac (lactulose) 2 tea spoon full at night and can increase amount as per requirement...
for delirium some thing u can do...
do not turn off light of her room at night...becoz it usually precipitated by decreasing sun light and becomes severe at night only...
do not allow her to sleep during day hours...

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