Dr. Ajay Panwar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
A 76-year-old female's computed tomography (CT) scan showed the following. Clinical information: CT scan of the head, volume scan of the whole brain obtained without IV contrast administration. Findings: Large cerebrospinal fluid (CSF) density hypodense lesion is seen in the right cerebellar hemisphere. Left cerebellar hemisphere, brainstem, and fourth ventricle are normal. Large irregular hypodense lesion is seen in right frontotemporoparietal lobe effacing the adjacent sulci and right lateral ventricle. An irregular hypodense lesion is seen in the left occipital lobe. Left lateral ventricle and third ventricle are normal. CSF cisterns are normal. No extra-axial fluid collection is seen. No midline shift noted. Densely calcified plaques seen in the cavernous segment of the bilateral internal carotid artery. Impression: Subacute infarct in the left occipital lobe, a subacute infarct in the right frontotemporoparietal lobe, a chronic infarct in right cerebellar hemisphere, densely calcified plaques in cavernous segment of the bilateral internal carotid artery. She has had two strokes so far and is in a critical condition. I wanted to reach out to see if you can provide a second opinion or if it is possible to get some of her senses back so that we can say our goodbyes properly to her.
Hi,
Welcome to icliniq.com. The computed tomography (CT) report which you have uploaded suggests large brain infarcts (attachment removed to protect patient identity). I would appreciate if you can upload the CT film also to have a better view of the same. Besides, in such large infarcts, many patients may not recover and some may recover partially. It depends on the clinical condition and consciousness state of the patient. Please upload the medical case summary as prepared by the treating doctors if that is possible for you. The probable diagnosis is stroke.
Patient's Query
Hi doctor,
We really appreciate the quick response. I have attached a photo of the film taken from my phone camera. Please excuse my stupidity if it is not the way this works. Also, attached a photo of the Mela supplement they are feeding her through her nose. Myself being a keto follower, I am not a fan of the high carbohydrates and sugar on this meal. Do you have any suggestions on the type of nutrition that is best for her? Unfortunately, I could not grab a copy of the patient summary prepared by the doctors. And thanks in advance. This is a great website and tool.
Hi,
Welcome back to icliniq.com. I have seen the computed tomography (CT) images and infarcts are of large size. As I said, chances of improvement are not a rule of thumb in such cases. The patient may or may not improve. Concerning nutrition especially in this critical phase of illness, taking this food supplement which is a balanced nutritional product (including concentrated carbohydrates) seems fine.
Patient's Query
Thank you doctor,
If you were the treating doctor, what are the five things you would try to either improve the patient's condition or bring the patient back to consciousness for a short period.
Hi,
Welcome back to icliniq.com. There is nothing like five things or n number of things. It is just that a neurologist has to keep the patient on universal protocol stroke treatment. The patient's airway, breathing, circulation, and nutrition has to be taken care of. Complications like bedsore, pneumonia and deep venous thrombosis are to be avoided. Doing all the good, some patients will eventually recover and some may not.
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Neurology
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