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Neurology (Expert Forum)
idi this cause her symptoms
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idi this cause her symptoms
by soobie, Apr 20, 2002 12:00AM
Hi,
My mom, 72, who 6 months ago was leading a normal, active life, is now immobile, totally incontinent and on a feeding tube (though lucid and able to speak.) In October she had carotid artery surgery. A few weeks later, emergency quadruple bypass. After the carotid surgery she was weak and in heart failure, but home and walking. Following the bypass, she deteriorated over a few months to where can't walk, roll over in bed, or use her arms much and is incontinent; has gastrointestinal problems (vomiting diarrhea); right hand shaking and in pain. She's on a feeding tube because there was damage to a nerve in her larynx during the first surgery. She passed the swallowing test but doesn't want to eat due to vomiting. The HMO didnt schedule a neuro eval until May, but she had a neuro consult in the hospital in Feb. when the peg tube was placed. The MRI report says: "evidence of small vessel disease with remote infarct right basal ganglia and right-side-of-pons." Would this cause her not to be able to walk? Would this cause her not to be ever able to walk? Her doctors in Florida can't seem to tell us why she is like this. Some suggest that her mental outlook is affecting her recovery. Thanks so much.
Sue
My mom, 72, who 6 months ago was leading a normal, active life, is now immobile, totally incontinent and on a feeding tube (though lucid and able to speak.) In October she had carotid artery surgery. A few weeks later, emergency quadruple bypass. After the carotid surgery she was weak and in heart failure, but home and walking. Following the bypass, she deteriorated over a few months to where can't walk, roll over in bed, or use her arms much and is incontinent; has gastrointestinal problems (vomiting diarrhea); right hand shaking and in pain. She's on a feeding tube because there was damage to a nerve in her larynx during the first surgery. She passed the swallowing test but doesn't want to eat due to vomiting. The HMO didnt schedule a neuro eval until May, but she had a neuro consult in the hospital in Feb. when the peg tube was placed. The MRI report says: "evidence of small vessel disease with remote infarct right basal ganglia and right-side-of-pons." Would this cause her not to be able to walk? Would this cause her not to be ever able to walk? Her doctors in Florida can't seem to tell us why she is like this. Some suggest that her mental outlook is affecting her recovery. Thanks so much.
Sue
Doctor's Answer
by CCF-Neuro-M.D.-JT, Apr 21, 2002 12:00AM
I'm very sorry to hear about your mother's condition or rather what we call "de-conditioning" since her recent major surgeries. It's difficult to accurately comment on an MRI that I have never seen (we never trust anyone's report unless we personally review them). But just going by the report you provide, it does NOT explain her current state. Small vessel disease is a term we use to describe little "ditzels" throughout the brain of no clinical significance in someone who has many stroke and heart risk factors such as your mom. Remote is a key word here. There appears to be evidence that your mom had small strokes on the right side of her brain and brainstem a while ago. If she did not have an episode or bout of left sided weakness in the past, then it is likely that the infarcts (strokes) described were clinically silent.
It is quite possible that she is requiring a lot of time to recover from her surgeries. This is something we see commonly at the CLeveland Clinic as we have many heart surgeries done here. Older patients coming out of very major, emergent heart surgeries as your mother can have a rough post op course and need more time and physical therapy to recover than a younger patient who went in for elective heart surgery. Her mental outlook certainly has an impact on her recovery as your docs have mentioned. If that MRI is recent and the reading is correct, there doesn't appear to be a neurological reason for her not to be able to walk from a brain standpoint. On the other hand, her medical/cardiac condition needs to be evaluated and management optimized for adequate recovery. Best of luck to you and your mother.
It is quite possible that she is requiring a lot of time to recover from her surgeries. This is something we see commonly at the CLeveland Clinic as we have many heart surgeries done here. Older patients coming out of very major, emergent heart surgeries as your mother can have a rough post op course and need more time and physical therapy to recover than a younger patient who went in for elective heart surgery. Her mental outlook certainly has an impact on her recovery as your docs have mentioned. If that MRI is recent and the reading is correct, there doesn't appear to be a neurological reason for her not to be able to walk from a brain standpoint. On the other hand, her medical/cardiac condition needs to be evaluated and management optimized for adequate recovery. Best of luck to you and your mother.
