Two strokes detected on the CT and MRI. How to deal with?

Question

Hello doctor,

My 62-year-old mother had a slight cognitive impairment. She has the following medical conditions: High blood pressure, for which she is on Concor 5 Plus. High blood glucose, for which she is on Galvus 50 and insulin. Three stents in her heart were operated on 18 months ago, and she is on Plavix and Aspirin.

We did computed tomography (CT) and contrast magnetic resonance imaging (MRI), and the doctor told us there were two strokes. We need to know how to deal with her issues now.

I have attached the report for your reference.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed the MRI (magnetic resonance imaging) brain report (attachment removed to protect patient identity).

I am sorry to say, but I do not agree with the diagnosis of subacute stroke as per the radiology report. The MRI that was done shows two lesions that are moderately large in size and do not follow the normal location for stroke. Also, we need other sequences, such as diffusion imaging, to say if it is a stroke or not.

Also, if that is a stroke, the symptoms would start suddenly with a left-sided weakness, like in the left arm or left leg, and facial droop on the left side. I would recommend you see a neurologist who can get a proper history about the onset of symptoms and do a neurological exam.

Also, if the DWI (diffusion-weighted imaging) sequence is not done on the MRI, it should be done to see if she had a stroke. Management of blood pressure and diabetes is a must, and she should continue with the Concor (Bisoprolol and Hydrochlorothiazide) and Galvus (Vildagliptin) plus Insulin. She should also continue Aspirin and Plavix for stroke prevention.

I hope this helps.

Answer 2

Hello,

Welcome back to icliniq.com.

No, I do not think this is bleeding in the brain. There is some minor blood in the two lesions as per the report. It is difficult to comment if Plavix (Clopidogrel) caused the minor bleeding. But the small bleeding in the lesion is not the concern. She probably needs the Plavix for her stents in the heart.

I hope this helps.