CT scan shows bilateral cerebral atrophy with delusion in an older person. What should be done?

Question

Hello doctor,

This is about a 71-year-old male. Psychiatrist said that a plain CT scan and another CT scan should be taken with contrast, but after four attempts they could not create channel in his veins, so contrast CT scan of the brain was not done.

Plain CT scan of the brain showed:

Cortical sulci, Sylvian fissure, basal cisterns at places and supratentorial ventricles are mildly prominent.

Lacunar infarct in right claustrum.

Mild bilateral cerebral cortical atrophy (age-related).

Background: He was unnecessarily fearing that my relatives, neighbors, and municipality will search and steal his clothes, newspapers. Only one day, he had a delusion about dead relatives making a phone call. After taking prescribed medicine Olanzapine 5 mg, one tablet per night, he is behaving properly. He is under medication for one and a half months. Previously he used to sleep for two hours, now he sleeps for four hours.

Answer 1

Hello,

Welcome to icliniq.com.

The symptoms you have described, of paranoid ideation, suspiciousness, restlessness, decreased sleep are all indicative of a psychotic type of illness, most probably schizophrenia. It will require treatment from a psychiatrist with antipsychotic medicines. Olanzapine is one such medicine. This happens because due to elevated levels of certain neurotransmitters such as Dopamine in the brain which leads to reduced stress handling capacity of the brain. The medicine will get the levels to normal and help with the problem.

For the first episode of this illness, treatment is recommended to be continued for one year and then medicines are stopped, for the second recurrence for three years and for the third time of recurrence it is lifelong. That is why please complete the course of the medicine as per the doctor's advice.

The lacunar infarct in the brain also is one contributory region for this problem and for that I am sure the other general physician or neurologists must have given medicines to take care of the infarct and anti-clotting medicines. If the size is small, please continue those and it will reduce.

Along with Olanzapine 5 mg, you can add Phenergan 25 mg (Promethazine). It will help him sleep better. Also, consider raising the dose to 7.5 if symptoms of suspiciousness do not reduce.

Answer 2

Hello,

Welcome back to icliniq.com.

In that case, I would recommend that you continue with Olanzapine for now. Give it once daily. Once the situation is fine, maybe after a month, you can get a neurologist to have a look at the report.

Also if he is on any other medicines like for high bp or diabetes, please continue to give them daily and if possible, monitor his blood pressure daily at home, if you have a portable digital BP machine. The infarcts usually happen due to raised BP which is not controlled.

CT scan shows bilateral cerebral atrophy with delusion in an older person. What should be done?

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