Q. Why did my father develop slurred speech two days back?
Hi doctor,
My 70 year old father has developed slurred speech from two days. He has diabetes, benign prostate hypertrophy, and 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 CT scan in the ER. His blood test including coagulation profile and troponin were normal. His HbA1C is 6.8, and the ECG was normal. Yesterday, the doctor started him on Aspirin 81 mg and Atorvastatin 40 mg. He is on Risperidone 1 mg more than 10 years without an obvious diagnosis. The psychiatrist started him on this medicine because of an acute psychotic disorder. An MRI was done last year, and I will upload the report. What should we do about the slurred speech?
Hello,
Welcome to icliniq.com.
- In a patient, having risk factors, like diabetes mellitus and acute onset 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:
- MRI of the brain or NCCT (non-contrast computed tomography) of the head.
- CPK (creatinine phosphokinase).
- Serum sodium.
- The possible differential diagnoses are:
- Acute stroke.
- Neuroleptic malignant syndrome.
- Worsening of psychosis and acute delirium.
- The previous MRI with past clinical history (attachment removed to protect patient identity), are suggestive of dementia. If the patient is not cooperative, then NCCT head must be done to rule out any bleeding inside the brain.
Revert with more information to a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist
Thank you doctor,
We took my father to an ER again today to get a CT scan. He did the CT scan, and an internal medicine physician saw the CT film. He said there is no stroke and no hemorrhage. I have uploaded the results of the blood test for your opinion.
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. But a normal CT scan does not rule out ischemic stroke. As small ischemic stroke can be missed in a CT, it will require an MRI of the brain to pick it.
For further queries consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist
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