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911Doctor, Doctor
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Experience:  Board Certified Emergency Physician
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I have just been informed that my incarcerated, out of state,

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I have just been informed that my incarcerated, out of state, 47yr. old brother has suffered multiple strokes at the base of his brain affecting his balance, judgement and memory. His CT scan and MRI from 2009 show numerous dark/black holes . . . quite unusual for a person his age and healthy physique (per the treating physician's phone conversation with me). They are planning to release him on medical parole as he was a non-violent offender and is not a threat to anyone. I was told he is on extremely potent HIV medication and has no signs in his blood or system right now but that same medication may be one of the causes of his brain condition. He has multiple holes in his brain, does not appreciate where he is or what year it is. He knows his name some days. He speaks slowly and deliberately. I was told he suffers from dementia that could be a result of the multiple strokes, HIV or medication; he has lost his ability for higher thinking. He needs help to eat, bathe, dress and is incontinent. He can stand and walk about two/three feet and longer distances with assistance. He is not angry or aggressive (he never was) and he smiles for no apparent reason. When I asked the doctor about his future and whether any of this is reversable, I was told that the incontinence is likely irreversible. Finally my question: Given the limited information I have submitted, do you believe any of his symptoms (esp. higher thinking) can be improved and what type of care do you recommend to facilitate his rehabilitation? Based on his needs, the prison doctor recommends a round the clock 24/7 care facility. What type of activities and interactions can you recommend to his family? Have you heard of this type of brain injury/damage from HIV medications? I do not know which particular drugs he is prescribed. Thank you for this service, your time and help!
Submitted: 5 years ago.
Category: Health
Expert:  911Doctor replied 5 years ago.
Hello and welcome to JustAnswer,

This is a very difficult question. The HIV medication, probably what we call 'triples'... meaning three meds for different purposes, can not cause this severe a dementia./ disability... that is, they usually do not....

But HIV disease can do just about anything to any part of the body and the brain is often affected.

I think speculation about the cause of your brother's disability is not profitable in this forum as I do not have his records to look at or his medication list and, of course, it is also at least possible that some of his disability may be exaggerated a bit on his part to get to the medical parole. Heck, if it were me, I would consider that. Also, in the setting of a prison, it may be very smart to put on a lot of overlying 'psychiatric' problems... might prevent harrassment from other prisoners.

So, my advice is this. Your brother has a bad disease and could be as disabled as you are being told. But what I would do if I were you would be to get him evaluated by someone who can do 'neurocognitive testing'.... a test that will be able to quantify the extent of his disability and neurologic compromise.

I think guessing about his true status at this point is futile and that you will need to get him evaluated by a neurologist on the outside who can review his records and studies and then perform the studies he or she feels to be necessary to make a good an accurate assessment of your brothers capabilities or lack of capabilities.

Do you have any further questions?

Customer: replied 5 years ago.

Believe me, I wish he was putting on an act. Unfortunately, his doctor confirms his abilities and physical functions are altered. The CT scans and MRI indicate something very real is going on, as indicated by the black holes and areas that appear on these tests . . . that is not made up. The affected brain area correlates to his limitations of balance, judgement and memory.


Is it a fact that some HIV medications cause some dementia? What about these effects as a result of the multiple strokes, what rehabilitative measures, one-on-one can the family offer? What information do you have as to any medications and/or therapies to help counteract brain injury/damage/trauma? Are there any specific interactions loved ones can perform to help?

Expert:  911Doctor replied 5 years ago.
do not misunderstand me, i am not suggesting this is an act....

i am suggesting that we can not get a clear picture until he is free and clear of the penitentiary....

and that the best way to get the clearest picture at that point is to have a neurologist review his mri and ct scans and do neuro-cognitive testing (if he thinks it appropriate) to get the clearest view of your brother's abilities or lack thereof.

to ansewer you questions about the medications i would, of course, need to know the names of the medications and how long he has been on them....

As to your question about multiple strokes, yes, there is something called multi infarct dementia which could possibly apply in your brother's case.

standing by.
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