continued loss of sensorium

Posted By  CCF Neurology MD:NT on December 08, 1998 at 01:54:23:
  : : In Reply to: loss of sensorium posted by cipi on December 07, 1998 at 09:56:18:
  : : It meant a lot to me and it is reassuring to know that you reach out to people in distress across the globe.
  : : i am unable to link it from the archive so would  request you to look at that so I don't  repeat  myself.
  : : My mother continues to be in hospital in india and altho' the MRI done on her in  oct.  had shown an infarct, the doctors were baffled by the loss of sensorium and felt that the stroke did not explain it all.
  : : The third MRI done on her now on 17th dec. has the following conclusion:
  : : 1 diffuse arteriopathic white matter changes with cerebral atrophy.
  : : 2 signal changes cerebellar  white matter  pontomesencephalic junction  pons &upper meddula nature of which is not specific.
  : : ?paraneoplastic phenemonena.
  : : ?demyelination  of any other eitology.
  : : ?ischaemic.
  : : consequent to this they have withdrawn the ATT treatment being done on her for possible tb meneningitis. They are not sure of the cause of  but do feel that a brain bioposy is not advisable in her condition(pl see my message in the archive). They are not in total agreement on the possibility of  it being  demylination or ischaemic. They have withdrawn ticlopidine after an episode of gastric bleeding caused while replacing  the nasal tubes . she remains on hypertensive drugs and half  aspirin daily.coticosteroid treatment was considered  but not started as she is diabetic(entirely diet controlled ).it remains an option which they are not very sure of pursuing .she continues to be on tubefeed,catheter,ripple bed and nursing care. She opens her eyes very occasionally on her own when being fed.or when someone enters the room.on command she responds very ocassinally,but looks at you if eyelids are drawn open  by us.
  : : I would like to know,
  : : 1 are these changes irreversible?and exactly what are white matter changes.
  : : 2 will corticosteroid  therapy help?(we are willing to take our chances on the diabeties )
  : : 3 are their treatments /diagnosis possible the have been missed?
  : : 4 can something be done to restore her conciousness .
  : : 5 can she hear/sense/feel pain  and can we alleviate her disress/isolation ?
  : : I would like that one chance a million to be also explored  for restoring her conciousness .is there anything possible.pl help !
  : : The detailed MRI report I am putting in the end so you may refer to it only if necessary. I apologise for the length  of this message but am anxious to provide  complete info.
  : :

[CCF Neurology MD:NT]

  : : REPORT
  : : MR scan reveals generalised  cerebeal atrophy with  widened extracerebral spaces and ventricular dilation.
  : : There is confluent hyperintense signal on t2w1 around the lateral  ventricles, more pronounced around the frontal horns. Also there are few discrete rounded hyerintense sigal fociin both centrum semiovale(L>R).similar changes are seen in the basal gangalia B/L. these findings of SCH's &PVH's are c/w arteriopathic/age related white matter changes.
  : : Note made of  ill defined  increased signal on t2 w1 within the central part of pontomesencephalic junction, extending  lower down  transversely into posterior pons as well as  upper medulla. These  were not  there in the previous  scan dated 7th oct. bilateral slightly asymmetrical(R>L) involvement of middle cerebellar penduncles &deep cerebellar white matter are also seen as on the previous scan&are possibly increased now.
  : : Rest of the structures including CP angles, orbits&sella (partial  empty) are normal. no extra-axial collection/neophlasm is seen .the major vessels show normal signal flows .
  : : CONCLUSION: