How to prevent the recurrence of hemorrhagic stroke?

Hello doctor,

My 72-year-old father had numbness in the left side of his body with palsy in the left corner of his mouth. We went to the emergency, and his BP was 130/78 mmHg. He was admitted for one week and was given antihypertensive and antidiabetic. When he was in the hospital, he developed right-hand cellulitis and was given antibiotics.

It is two weeks now since he was discharged. His condition improved. He is mentally very healthy nothing has changed since his hemorrhagic stroke. He can walk and sit without help. And also, there is no numbness, and his face and mouth look normal now.

Before his stroke, he had been taking low-dose Aspirin for a long time. Kindly review his brain images and read the report. I would like to know everything about his condition.

What is small artery disease? Is it dangerous? Can it be prevented?

Thanks.

Hello doctor,

Thanks for the reply.

In his CT report, it was mentioned that he has small artery disease. What does it mean? Is it dangerous? When will the blood in his brain go away?

He chokes during drinking and eating. Is there a cure for his choking problem?

Thanks.

Thank you doctor,

We had MRI. This is the result. There is a mild irregularity of vessels along the circle of Willis in keeping with mild atherosclerotic changes. There is no significant stenosis or occlusion in major vessels. There is hypoplastic right A1 segment, right vertebral artery, and fetal right PCA. There is no definite vascular malformation or aneurysmal dilatation along the circle of Willis. The impression shows mild atherosclerotic changes along the circle of Willis. The following findings are seen. Abnormal signal intensity is seen in the right basal ganglia with mild perilesional edema. It shows high signal intensity on all pulse sequences with a low signal intensity rim on T2-weighted images. The appearances are likely due to a small subacute hematoma in the right basal ganglia.

There are multiple small scattered areas of old ischemic infarctions in the basal ganglia, thalami, posterior limb of the internal capsule, and adjacent external capsule, pons with faint changes in the cerebellar hemisphere. There are prominent Virchow robin spaces in the basal ganglia likely in keeping with underlying neurodegeneration. There are significant microvascular ischemic changes in the white matter associated with chronic lacunar infarcts in the periventricular region.

There is no definite intracerebral mass. Ventricles and cortical sulci show age-related involution. There is a compressed pituitary gland in keeping with empty sella turcica. Bilateral cavernous sinus are shown. Both vestibulocochlear nerve complexes are intact. There is a subtle irregularity in the right cavernous carotid likely due to atherosclerotic changes. There is no midline shift seen. Chronic mastoiditis is seen. Mucosal disease in the paranasal sinuses with polypoid changes in the right maxillary, the possibility of superimposed fungal colonization cannot be entirely excluded.

The MRA circle of Willis exam shows mild irregularity of vessels along the circle of Willis in keeping with mild atherosclerotic changes. There is no significant stenosis or occlusion in major vessels. Hypoplastic right A1 segment, right vertebral artery, Fetal right PCA is also seen. There is no definite vascular malformation or aneurysmal dilatation along the circle of Willis.

The impression shows a small subacute hematoma in the right basal ganglia. Significant microvascular ischemic changes in the white matter with multiple old ischemic infarctions showing lacunar infarcts with neurodegeneration as detailed above. There is no intracerebral mass and empty sella turcica. There is a mucosal disease in the paranasal sinuses and mild atherosclerotic changes along the circle of Willis.

Thank you doctor,

Is there anything serious in the white matter? What is the risk of having it? Is there anything to do to lower his blood pressure? Even after taking medications, it is still at 135 to 145 mmHg.