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Stroke/CNS probs' eitiology/treatment
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Stroke/CNS probs' eitiology/treatment

Mom 72, Singapore. Diagnosed w/ HTN '92.  5/’09, hospitalized due to methyldopa induced cholestasis, diagnosed w/ A fib. 8/’09, 14 days into Warfarin, she fell (cause unknown), suffering a skull fracture causing an acute subarachnoid and subdural hemorrhage.  Initially paralyzed left side & recovered almost 90%.  On our request, switched to Aspirin.
12/’09, open cholecystectomy due to acute cholecystitis w/ 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 Apaxiban vs Warfarin clinical trial back in 8/’09.)
Daily BP:
B4 breakfast - 140
PM & eve- 120
She take her BP medicine after breakfast.

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? What testing should be done?
3. Should she be on the statin drug rather than a regular, time-tested BP med (like her original BP meds listed above)? Don’t statins have dangerous side-effects?
What should be the proper treatment regimen? Shouldn’t she be taking BP meds other than statins, especially while on Warfarin? And aren’t blood thinners possibly contra-indicated by her history?
Could her reduction in pain on the shoulder cause by the anti-inflammatory effect of the statin ? I have read numerous articles regarding the dangers of statins and am very concerned.
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1083596_tn?1313398276
Thanks for posting through my forum.
I read the history.And it suggests a  neurology problem only .
Her main doctor should be a neurologist only.
As you said ,she fell and suffered a skull fracture,this is the main cause of haemorrhage (subarachnoid +subdural).
She is a hypertensive patient that was another added factor.
Statins are use for hypercholestermia and have got no serious side effects.
She can definitly start with statin therapy only after her lipid panel checked.
As i see her history of hemorrhage,warfarin like drugs should be used cautiously,as these drugs have got anticoagulant action.
Treatment (acc. to the history mentioned ) will be 1.Antihypertensive.
2.Statin/nonstatin.
3.Analgesic if required.
4.Physical Therapy.
5. Spiritual consult.

No need for any other tests.
I guess this will suffice.

Regards
Abhijeet.

2 Comments
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1083596_tn?1313398276
I am trying to give you the answer, but the website is not accepting.. Will try today evening again...
Thanks for your patience.
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