My 81 year old mom was admitted through the ER for a variety of tests to discover the etiolgy surrounding a goose egg which appeared on her forehead without any history of fall or other trama event. Her history includes Alzheimers, COPD, CHF, stage 3 renal failure, HBP, osteoarthritis, diverticulosis, bleeding ulcers, ventral hernia and bilateral inguinal hernias, type 2 diabetes, heart stents, heart attack and pacemaker. Lab work shows her Potassium is elevated, CT of head is negative, CT of abdomen is negative, and carotid doppler shows 79% occlusion. She is allergic to Plavix and cannot tolerate blood thinners because of a history of bleeding ulcers as well as AVMs in upper abdomen. The hospital that my mom is in is VERY small in a small town and the hospitalist in charge of her care recommends going home and doing nothing; rechecking her condition in 6 months. Somehow, I feel that if we follow his advice my mom may not be around in 6 months. Can something else be done? Help!
I don't understand your question: she was admitted for the workup of a mass on her forehead. The head CT was negative, but what did it say the nature of the mass was? I suspect this is not secondary to any CVAs, but may have been an undocumented fall.
About the occlusion, our workup included an MRI of the brain. If it shows any evidence of embolic events on that side ( the side of the 79% occlusion) then either a CEA or a carotid stent procedure is attempted. If there are no significant lesions found, then it depends on her symptoms: is she having weakness, droopiness of her face, dis-orientation? If so these may be related to the obstruction, and she should get that taken care of. Irrespective of any interventions, medical therapy with statins and blood pressure control. Also either aspirin or ticlodipine can be attempted to be used, provided she has not had any recent black or bloody stools, although there is a risk of GI bleeding. But at 81 years of age no action in undertaken without a degree of risk: you have to decide what amount of risk you wish to take.
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