What could cause neurological problems in a 70 y/o diabetic?

Question

Hi doctor,

My 70-year-old father has developed slurred speech for two days. He has diabetes, benign prostate hypertrophy, and a history of vascular dementia. He does not have weakness, paralysis, or numbness. He does not have hypertension or any cardiac disease. He refused to do a computed tomography (CT) scan in the emergency room (ER). His blood test including coagulation profile and troponin were normal.

His HbA1C is 6.8, and the electrocardiogram (ECG) was normal. Yesterday, the doctor started him on Aspirin 81 mg and Atorvastatin 40 mg. He has been on Risperidone 1 mg for more than 10 years without an obvious diagnosis. The psychiatrist started him on this medicine because of an acute psychotic disorder. A magnetic resonance imaging (MRI) was done last year, and I will upload the report. What should we do about the slurred speech?

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

In a patient having risk factors, like diabetes mellitus and an acute onset of slurring of speech, it raises the possibility of developing an acute stroke. Though there may be other causes, too. I would suggest undergoing the following tests:

1. Magnetic resonance imaging (MRI) of the brain orNCCT (non-contrast computed tomography) of the head.

2. CPK (creatinine phosphokinase).

3. Serum sodium.

The possible differential diagnoses are:

1. Acute stroke.

2. Neuroleptic malignant syndrome.

3. Worsening of psychosis and acute delirium.

The previous MRI with past clinical history (attachment removed to protect patient identity) is suggestive of dementia. If the patient is not cooperative, then an NCCT head must be done to rule out any bleeding inside the brain.

I hope this answers your query.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The attached reports (attachment removed to protect patient identity) are not clear. You need to upload them again. As you mention that there is no hemorrhage or bleeding in the CT scan, then tablet Aspirin and other medicines can be continued. Buta normal CT scan does not rule out ischemic stroke. As a small ischemic stroke can be missed on a CT, it will require an MRI of the brain to pick it up.

I hope this helps you.

Thank you.