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Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
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Experience:  Neurosurgeon - Brain, spine, and peripheral nerve surgery
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My husband has had dementia for eight years following emergency

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My husband has had dementia for eight years following emergency brain surgery for a subdural hematoma (alcohol dementia).
He has been rapidly deteriorating neurologically for the last six weeks--can't stand or walk without assistance, walks on his tiptoes, legs and knees are locked together, leans sideways when he is "walking," hands, especially left one, are clutched and rigid, little speech and unclear.
Is this an end-stage syndrome? What is going on?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Mark replied 1 year ago.
Hello.

The rapid deterioration you describe is certainly not the typical dementia syndrome, and given that he is having a significant and worsening neurologic issue -- at the minimum, I would get a CT of the brain.

This is to ensure that there is not another issue in the brain - such as a chronic subdural hematoma - which can occur, put pressure on the brain - and cause problems such as the above, which come on quickly. Certainly because he has had a history of this in the past- he is at higher risk for this occurring.

Of course - the medications that have been stopped could also be playing a role in this,though one would not expect this to cause a continued, rapid deterioration.
Customer: replied 1 year ago.

He had a CT scan to rule out another hematoma. These are the notes and the comparisons with his last CT scan:


1. Increased prominent supratentorial small vessel ischemic change with small progressive lacunar infarcts in the basal ganglia, thalami, and internal capsules.


2. Progressive localized chronic infarcts of the inferior margin of the right temporal lobe.


2. Small cortical infarct of the posterior margin of the right parietal lobe, equivocally increased.


4. Progressive prominent ventriculomegaly. The cortical sulci are larger as well so cortical atrophy is favored over hydrocephalus.


5. Persistent stigmata of extensive right craniotomy.


6. No intracranial hemorrhage.



Can you put this into everyday language? And would these findings explain his deterioration?


His neurologist was concerned about bleeding and did not seem as concerned about these other changes.

Expert:  Dr. Mark replied 1 year ago.
OK.

This just says that he has some evidence of previous strokes throughout the brain.

There is evidence that there has been some "shrinkage" of the brain.

There is evidence of the previous surgery.

No bleed.

So, this shows that his brain has suffered from the effects of multiple strokes in the past, and can explain dementia, but not clearly explain a reason for a rapid deterioration. None of the changes seen on the CT are new, hence why the neurologist likely was not as concerned about the CT scan.
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 11946
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
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