My father is 75 years old and lives alone in India. He is 5 ft 3, 120 lbs and has a waist size of 35 inches. He walks a mile daily and uses his exercise bike for 30 minutes daily. His blood pressure, cholesterol and sugar values are normal. He sees his primary care physician every three months.
In 2001, he was diagnosed with Glaucoma. He has been seeing an Ophthalmologist ever since. My father has had no trouble with his vision. On 05/20/2012, his Glaucoma Specialist did the annual visual field test and told my father to get a CT-scan of his brain for further investigation of his results. His eye pressure in both his eyes were 10 mm Hg.
The CT-scan of the brain had the following abnormal findings:
a)Chronic lacunar infracts are noted in both external capsules.
b)Visualized paranasal sinuses; scattered mild inflammatory mucosal thickening noted in the paranasal sinuses.
c)No other significant abnormality detected in the study.
Upon learning of the results, the Glaucoma specialist told my father that at some point in the past, he must have had blood flow issues to his brain and that he should see a Cardiologist. Further, he would speak with the Cardiologist about my father's abnormal findings.
(When my father visited the US in Oct 2009, he had a fall in the bathroom. He was taken to the ER and among other tests, the CT-scan of the head was normal and the reason for his fall was post-urination syncope. He was fine the same day)
a) How serious and life-threatening are the findings in my father's CT-scan of his brain? Is he at risk of a full-blown stroke at any moment?
b)Since my father's blood pressure has been normal and the
CT-scan of his brain in Oct 2009 was normal, what would have caused the chronic lacunar infracts in his brain between Oct 2009 and now?
c)Would you recommend my father see a Neurologist as well?
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.
To begin with, I suggest that he see a neurologist. It would be important to look at the CT and examine him to ensure there are no neurological deficits. Sometimes, there are “plaques” in the same region which can be clinically silent. These plaques are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented. However, if it was truly a stroke, finding the cause (such as what was the clot from the heart?) and preventing future strokes is important. Having a stroke does put a person at risk of having another. Again, I suggest your father see a neurologist in addition to his other physicians.
Thank you for using the forum, I hope you find this information useful, good luck.
My father saw a Cardiologist and a Neurologist over the past two days. After looking at the CT-scan of the brain(report and the negatives) and examining his work-up from the Glaucoma Specialist, they both said that he is fine and does not need any further tests as it relates to lacunar infarcts or an ultrasound of the neck to check for blood clots. The reasons given were that his blood pressure, cholesterol, sugar values and body weight are normal and that he has an active lifestyle and lacunar infarcts were due to his age.
I wanted to know if it would be wise to talk to another cardiologist and ask for the ultrasound of the neck(to rule out blood clots)?
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