First of all sincere aplogies for my repost, I'm desperately looking for opinion in case of my father health and here is the case, My father had undergone two opearations one in 2006 (at that time I have posted a question in this medhelp form for myelomalacia treatment http://www.medhelp.org/posts/show/297282?personal_page_id=193242&post_id=post_1821192 ) and another one in March 2008 (as there was another compression in the lumbar area of the spinal cord). After this operation his legs improved a little bit and he regain control of his bowl movement, but still could not able to walk even with support of a person and also a walker. Recently, he started a symptom of talking incoherently (initially started after waking up from deep sleep and now it progressed), and then comes back normal with in a minute or so. We had consulted a pyschiatrist for this and he advised to go for an MRI of brain. The report now shows below.
a)TR weighted hyperintensities involving right mid-brain(Ischemic area).
b)Diffuse cerebellar atrophy
Is there any thing new in this kind of a case in the medicine or advise if some thing can be done to my father to improve his condition atleast to walk little bit and stop talking in-coherently. Appreciate any help in this. My father is 68 years old, so thinking of not to go for another operation given these symptoms.
Thanks for using the Forum. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to take a history and examine your father, I cannot tell you what the cause of his symptoms is. However I will give you some information that I hope will be helpful.
Seems that he is having episodes of confusion. His confusion is not likely related to his back surgeries or his previous back problems. Patients can develop confusion for many reasons, including conditions that produce dementia, like Alzheimer’s disease. Dementia is manifested as memory loss, behavioral problems, and progressive deterioration of executive function, interaction with other people, and episodes of confusion. There are many causes, as I said including Alzheimer, but also previous strokes, or other rarer conditions.
Confusion can also be caused by metabolic problems like “low sugar”, problems in the liver or kidneys, or infections even such as urinary infections. This issues should be investigated.
There is a conditions called normal pressure hydrocephalus that produces confusion and changes in mental status, along with gait problems and urinary problems. Usually this is evident on a brain MRI, and if evident, may need a spinal tap to make the diagnosis, and eventually treat it. Sometimes problems that affect memory and produce confusion can also affect the spinal cord, however in your father’s case, the back problems were in the past, and at this moment I am not sure if they are related.
It is important that you recognize other of the manifestations that come along with confusion in dementia syndromes, and these include memory problems, inability to interact and establish complex conversations, problems with attention, arithmetic, and other disorders of mental function.
From your description, I cannot really say if your father has all this other manifestations other than “talking incoherently”, and therefore I cannot say if what he has is something related to dementia or not. Dementia sounds scary, and you should not think about this diagnosis without a formal evaluation by a physician in order to be able to make this diagnosis. Just waking up and talking incoherently does not make this diagnosis, and as I said, I cannot tell you anything definitive just by your description.
The MRI of the brain that you describe does not report enlarge ventricles, which is what you see on “normal pressure hydrocephalus”, but this should be considered in the possible diagnosis, and a neurologist by seeing the MRI may be able to tell you. Regarding this MRI, it is very difficult to tell you a conclusion, as in order to be able to comment on an MRI I will need to see it myself.
As I wrote before, without being able to take a detailed history, and performed a neurologic examination, I cannot tell you what the cause of your dad’s problems is.
I think it is very important for him to see a neurologist, and find out what exactly the condition is that is affecting him, in order to consider treatment that may help him.
I hope this information is useful. Good luck.
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