my father is a pt of myelodysplastic syndrome , refractory anaemia with ring sideroblasts, has been transfusion dependent , needs 5-6 packed RBC transfusions in a month for last few months , he is a diabetic but not hypertensive keeps BP around 120/80mmHg . 1 month before he had weakness and imbalance on walking and detected to have bilateral subacute subdural haematomas with slight midline shift, right one being 1.93cm and left one 1.2 cm in width .we could not find a h/o significant head trauma . he does not take anticoagulents or antiplatelets and his bleeding and clotting profile was normal . bilateral burr hole drainage was done a month beforeand he recovered well thereafter . one week back we found the recurrence of bleed , hence he was subjected to craniotomy .on the second day post craniotomy he became drowsy and incoherent .found to have recollection post surgery . redrainage was done again the next day . post course was stormy he was put on ventilator and regained conscious ness after 4 days . surprizingly he developed sever hypertension post surgery , BP shooting to 200/90mmHg , which is still uncontrollable on triple antihypertensive drugs + hehas lability in it . he has difficulty in speech , voice has become hoarse, and still looses the link while he talks . i want to know as to what is the cause of his de novo hypertension and speech difficulty. a plain CT scan before discharge is not having any significant collection . can myelodysplasia without afecting thenumber of platelets be responsible for rebleed due to thrombesthenia . how can we manage his hypertension ? and whether there can be a parenchymal injury to his brain . he was quite OK and asymptomatic before second craniotomy .he curses himself being subjected for surgery as he was able to fulfill his daily tasks without help before surgery .
I went through two craniotomies myself but mine were for an internal EEG and then about a week later a right temporal lobectomy for seizures. I healed very quickly but it sounds like there were complications in your father's case. As far as the high BP goes though...is he on a low sodium diet? Sodium (salt, MSG, etc) can increase BP. If he hasn't already done so, he should reduce his intake of it.
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