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Dr. Muneeb Ali
Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 7425
Experience:  MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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My sister had a bad fall, backwards down a set of stairs in

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My sister had a bad fall, backwards down a set of stairs in April, resulting in a compression fracture in her neck, broken clavicle and the initial CT scan showed blood on her brain. A subsequent CT scan showed this had cleared. In the last 4 months she has fallen numerous times, and is presently in a rehab facility. For the last 2 weeks she has experienced 5 falls, had a pacemaker placed, and is experiencing dysphagia, urinary incontinence, and accelerating confusion. Her speech is now so soft and nonsensical that speech intelligibility is at about 5%. After a CT scan yesterday, it was revealed that she has a sacral fracture. They are unable to do an MRI secondary to a vagus nerve stimulator placed in her left chest, and now a pacemaker in her right chest.
JA: How long have you been dealing with this issue? Are you experiencing any numbness or tingling?
Customer: Since the bad fall in April. I might add that my sister will be 77 in October, is bipolar, and has been on psychiatric meds most of her adult life. No complaints of numbness or tingling.
JA: Anything else in your medical history you think the doctor should know?
Customer: Her psychiatrist recently changed one of her psychiatric meds as she had been on Parnate for decades. I know that she is taking blood pressure meds, thyroid meds and probably many more. I might add that she has been overweight most of her adult life, but has gained a considerable amount of weight the past 6 months. She is about 5'6" and I believe she is now well over 200 pounds.

Hi,
Welcome to JA and thanks for this question. Im sorry to hear about your sister. Can i ask did she get a CT scan of the brain done after the last fall within the last two weeks? If so did it show any new changes in the brain? If you have a report of the Ct scan that would be useful.

Customer: replied 30 days ago.
No CT scans of the brain since the fall in April.

Thanks for the additional information, let me just write down an answer for you and ill get back to you in a few mins. If you get a phone call request, that is an automated site response. I DID NOT send it. Thanks!

Actually from what you are describing it sounds like that your sister may have developed Normal Pressure Hydrocephalus or NPH. This is a condition in which there is collection of fluid within the ventricles which are the cavities in the brain which contain CSF. This can occur even after the sort of trauma that you sister had, the presence of repeated falls, confusion and incontinence can all indicate that this is the problem. Secondly it can also be post traumatic hydrocephalus which can present in this manner as well. This is a condition which can be easily diagnosed on the basis of a simple CT scan as well and a MRI is not necessary in all patients.

So the first order of business here is to get a repeat CT scan of the brain done, if it shows hydrocephalus or either variety she needs to be started on medications and if necessary a shunt has to be placed in the brain to drain the excess fluid into the abdominal cavity. Usually once the pressure is relieved the neurological symptoms can resolve. My suggestion is to get an immediate CT scan of the brain done here.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

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Customer: replied 30 days ago.
NPH makes so much sense! Her cardiologist was banking on it being her heart condition. Can NPH also be responsible for a-fib, drop in blood pressure?

That is less likely to be due to NPH, however it is likely that the afib is leading to teh drop in BP and the afib is a consequence of another underlying issue. That should be investigated separately as well.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Customer: replied 30 days ago.
Only one question, how much is this costing me? You have been most helpful, thank you! 5 stars for sure!

The cost is determined by the site administration as that is out of our control, the experts. But it shows here that you are being charged $22 by the site. You can confirm this by contacting customer services if you want.

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