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

Hello doctor,

This is on behalf of my mother, aged 82. She does not have sugar, blood pressure, or cholesterol 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 tumor was removed. The postoperative pathology report showed some traces of not-so-malignant carcinoma. The surgeon sent her to a regional cancer center for review. The RCC advised her to take the tablet Imitab for one and a half years. After that, she has been visiting the RCC for a periodic check once in three months. Nothing unusual has been found so far.

Now my mother is experiencing certain other problems. She is always restless. She never lies down or sleeps in the daytime. During the 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 of intracranial pathology for generalized hyperpigmentation.

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 this behavior temporarily till the test is taken and regular treatment is started.

Hello doctor,

Your advice has been very valuable. I am greatly astonished at the exactness of your listing of my mother’s other symptoms that I have not narrated to you. You are one of the best physicians I have come across. She indeed has severe constipation. She has good presence of mind and she has somehow discovered the cure for constipation all by herself. She insists on eating plantain fruits every day, and I happily give her at least six fruits every day without fail. She also asks for several glasses of hot water, preparatory to her emptying of bowls. 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 when she has a free and complete discharge from her bowels, her disturbances are relatively mild.

Your listing of symptoms for delirium perfectly matches my mother's. She always searches for something in the bed, under the bed, on the floor, on the shelves. She will not allow a bedsheet or pillow to 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 misplaces them. Fortunately, she sees no insects or snakes. She goes in front of the full-length mirrors, makes gestures at her reflection, and talks to it. She had never failed to recognize a family friend or acquaintance. Her memory of the remote past is excellent. She recognizes and remembers political leaders on TV. Even when she has delirium, restlessness, or agitation, she returns to normal 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.

Over the years, she has also developed some small semi-spherical projections of a 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 laboratories? Does it require hospitalization?

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 will be very kind of you if you provide early and detailed advice.