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Need Urgent Advice on Basal Stroke--PLEASE HELP
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Need Urgent Advice on Basal Stroke--PLEASE HELP

My uncle just had a major stroke, and I apologize in advance for the long post, but I'm soliciting any and all advice on what we should do.  It has been a week now and he is still in a coma, and the neurologist is not very optimistic.

Patient history:  
Sanjay Patel 47 years old man with diabetic mellitus, diagnosed about a year ago.  He also has hyperlipidemia and history of asthma.

Clinical history:
Patient has complained of persistent headache, floaters in his left eye lasting about 5 seconds at a time. He also had hyperglycemia which could not be controlled by medications.  

March 6th
01:00am- Started vomiting, had a headache, feeling dizzy and confused.
02:00am- symptoms above got severely worse, and lost conciseness, blown pupil.
03:30am- patient arrived at the hospital emergency center.

CT scan report: date- 03/06, time- 07:00am.

Findings:
Ventricles, sulci and cistens are within normal limits.  Midline structures are in normal position with no evidence of mass effect.  No acute intracranial hemorrhage or depressed skull fracture is seen.  There is some fluid and mucosal thickening in the paranasal sinuses.  

MRI  Scan Report: date- 03/06, time- 09:00am.
Findings: There appears to be acute infarct involving much of the right cerebellum.  Left cerebellum is less significantly affected.  There are also infarcts which are sub centimeter in size in the right occipital lobe.  Lacunar infarcts in the left occipital lobe are less prominent.  No significant mass effect or midline shift is seen at this time.  Follow up will be necessary.  Basilar flow void appears to be abnormal.  

No abnormal areas of contrast enhancement are seen.  There is a mild patchy white matter disease.  There is mucosal thickening, mucosal retention cyst, in the paranasal sinuses.

Impression:
1. Multifocal acute infarcts in the posterior circulation, basilar flow void is abnormal.
2. Mild patchy white matter disease is non specific but may be secondary to small vessel ischemic changes.
3. Paranasal sinus disease.

Ct scan report: date- 03/07, time- 10:30am.
Findings:  
There are areas of worsening hypodensity in the right greater than left occipital lobes and temporal lobes.  There is larger area of right cerebellar hypoddensity.  Given findings of multifocal infarction on recent MRI examination, these findings likely represent progression of infarction.  There is a new hypodense lesion detected in the left thalamus measuring 0.6cm in diameter.  There is mild enlargement of the bilateral temporal horns which is  increased from previous exam.  There is worsening obscuration of quadrigeminal plate and ambient cisterns.  The third ventricle is mildly enlarged.  

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