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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Neurology
Satisfied Customers: 55803
Experience:  Medical Doctor Trained at a Top Academic Institution
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On May 20 my husband was brought to the ER after he was

Customer Question

On May 20 my husband was brought to the ER after he was stopped for driving dangerously. He was also delusional and paranoid. The ER physician ordered a CT scan to rule out anything physically as my husband had no history of mental illness and admitted him to the psychiatric ICU for observation. The CT scan was not done until May 28 and no one shared the results with us then or ever. His paranoia persisted funtil about May 25 and then cleared. He was on 50 mg Seroquel. On May 29 he was discharged with a follow up psychiatric appointment scheduled for 2 months later. He went on a leave from work and his insurance company requested all his records. We picked them up on July 17 and reviewed them before sending to the insurance company. In them were the results of the CT scan. It indicated he had a small lacunar infarct in the right basal ganglia putamen, .8x1.2 cm, likely subacute. After many calls to the patient safety officer at the hospital, the psychiatrist phoned and apologized and set up a referral to a neurologist for Sept 18. We didn't feel like we should have to wait that long to have this explained and for him to know what he should and shouldn't be doing. We went to the ER and the doctor apologized and set up a Carotid Doppler, Echocardiogram, additional CT and Halter Monitor. Blood work was also drawn. She suggested he attend the Stroke Prevention Clinic at the hospital. He went there the next week and was seen by a retired internist who works in the clinic part time to help out. He suggested that my husband had not had a stroke as he had no other symptoms and that he likely just had a psychotic break. Can you explain what "subacute" means and whether or not this event could be related to his behaviour that day? He had a bad headache for 3 days before May 20 and was not able to sleep well. He also seemed suspicious and quite emotional. He is not normally like that and has not been since coming home.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Phil, MD replied 1 year ago.

any other medical issues?

Customer: replied 1 year ago.
No, he's been totally healthy. He's not overweight or diabetic. About 5 years ago his work doctor said that he might have high blood pressure but later said it was likely related to work stress. His blood work all came back fine as did the echocardiogram and the carotid doppler test.
Customer: replied 1 year ago.
His appointment with the neurologist for Sept 18 was cancelled by someone at the hospital, they're not sure who. They can't fit him in now until Mar 14, 10 months after the whole incident. He was charged at the time with dangerous driving and has to deal with the legal repercussions. We've spoken with the arresting officer who has said that if he had a stroke then the charges might be withdrawn. If he had known that at the time of the incident when the CT scan was supposed to be done, he may not have been charged at all. My husband was 50 at the time of the incident in May.
Expert:  Dr. Phil, MD replied 1 year ago.

why was he on seroquel in the first place?

Customer: replied 1 year ago.
Psychiatrist prescribed it for him in the psychiatric unit. He's been on it ever since. Our family doctor wants him to not take it. He feels like it helps him sleep which was a big problem prior to May 20.
Expert:  Dr. Phil, MD replied 1 year ago.

So he has no psych history and was on no meds when this happened?

Customer: replied 1 year ago.
That's right
Expert:  Dr. Phil, MD replied 1 year ago.

Hmmm...I find it hard to believe it was a psychotic break.

I think it was the stroke

Expert:  Dr. Phil, MD replied 1 year ago.

subacute just means a few days to weeks old. And yes this explains his actions and headache

Customer: replied 1 year ago.
What does subacute mean? Is a lacunar infarct a stroke? The doctor in the stroke prevention clinic said he would not call this a stroke.
Expert:  Dr. Phil, MD replied 1 year ago.

yes a lacunar infarct is a stroke

no offense but the retired internist might be out of touch

Customer: replied 1 year ago.
He had no paralysis or numbness. Would a stroke in that area of the brain cause paranoia and delusions about safety? He thought someone was going to shoot him and that he had to get somewhere safe. He said he knew the police would take him to the hospital or to jail and he'd be safe.
Expert:  Dr. Phil, MD replied 1 year ago.

Yes, it could cause this. Absolutely

Customer: replied 1 year ago.
Is it reasonable to wait 8 days for a CT scan ordered in the ER?
Expert:  Dr. Phil, MD replied 1 year ago.

No. absolutely not. that is unacceptable

Customer: replied 1 year ago.
The neurologist we are supposed to see in Mar is also retired but is well-known and respected as a teaching physician at the University of Western Ontario. Should we wait until Mar or push to get in some where else?
Expert:  Dr. Phil, MD replied 1 year ago.

I would push to get in somewhere else. March is way too long

Expert:  Dr. Phil, MD replied 1 year ago.

Please don't forget a positive rating. I appreciate it.

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