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1069105 tn?1256704012
Stroke/CNS probs' eitiology/treatment
My mom is a 72 year old female living in Singapore and diagnosed with hypertension 8 years ago (which was initially controlled via wel-known BP medications, but which medications she is no longer prescribed for unknown reasons.) In 5/09, while hospitalized due to methyldopa induced cholestasis, she was diagnosed with atrial fibrillation. In 8/09, 14 days into Warfarin therapy, she fell, suffering a skull fracture causing an acute subarachnoid and subdural hemorrhage.  She was initially paralyzed on her left side.  She recovered almost 90% after 3 weeks.  On our request, she was switched from Warfarin to 100mg Aspirin.
In 12/09, she had an open cholecystectomy due to acute cholecystitis with pigmented gallstones.
In 5/10 , she had a minor stroke.  Her eyesight became blurry, she vomited twice and lost motor control, especially on her left side.  She was discharged from the hospital after 1 to 2 days.  She is now back on Warfarin with the same cardiologist who recruited her for the Warfarin related clinical trial back in 8/09.

Sadly, she has been suffering slowly decreasing lucidity after the 8/09 hospitalization, with etiology uncertain.

ECG results:
4/09: Sinus Bradycardia & Atrial Premature Complex
5/09: AF, T abnormalities
8/09: (hospitalized for CNS hemorrhages) Sinus rhythm
10/09: AF, T & ST abnormalities

Medications BEFORE 5/10 stroke:
30 Amlodipine Besylate: 5 mg
Lisinopril: 40 mg
Atenolol: 50 mg
Omeprazole: 40 mg
Aspirin: 100 mg

Medications AFTER 5/10 stroke:
Simvastatin 10mg
Warfarin

She has no other risk; CHADS is "1".

1. Her stroke symptoms indicate neuro problems. Shouldn’t a neurologist be her main Dr.?
2. Was her stroke most likely secondary to a blood clot (i.e., blockage), or hemorrhaging due to capillary wall weakness secondary to either genetic propensity or vascular wall compromise due to long term hypertension? How do we determine this?
3. Should she be on the statin drug rather than a regular, time-tested BP med (like her original BP meds listed above)??
What should be the proper treatment? Shouldn’t she be taking BP meds other than statins, especially while on Warfarin? And isn’t Warfarin possibly contra-indicated by her history?
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