Unexplained Coma

[NormaJean1964]

Help! My mom is in a coma and the doctors cannot understand why. She had a stroke (left cerebellum) the end of Jan or first part of Feb. She was doing great but I noticed around the 11th, she was declining. After many doctors denying her condition was worsening and countless tests, she is now in a coma like state. Her latest MRI shows white spots. They were not present on her MRI from 2/24. All blood work comes back normal. No signs of infection. She had 16 white blood cells in her spinal fluid. The infectious disease doctor says that indiciated inflammation not meningitis. They aren't ruling it out but don't feel  that is what it is. Her EEG shows slow activity non specific. They have found no blockages and no clots. She was a healthy 79 year old asian female. She turned 79 on 2/10. She exercised daily, watched her weight and what she ate. She does not drink nor smoke. Prior to the stroke she was borderline diabetic and her cholesterol was slightly elevated but not enough for meds. I feel something is wrong with the cultures and blood tests. Her SED was normal even though she has RA. She had an ongoing UTI infection since the summer. She has been on countless antibiotics. As of 2/9 she still had the UTI. They detected a trace amount of E-coli in her urine. She was put on Macrobid. The tests now show no signs of an infection. I don't understand the medical jargon but my understanding is that she shows signs of a UTI infection such as blood in her urine and other stuff but her white blood cell count is normal so they have ruled out a UTI. How did one that had no cleared up in months, finally clear up? Oh yes, my mom was dehydrated too but all tests did not indictate she was dehydrated. She had not ate or drank anything in several days. Her urine was very dark and foul smelling. It looked like apple cider at one point. She was put on an IV drip. She began to have difficulties urinating. Nothing would come out. A bladder scan was done and her bladder was full of urine. A foley catherater was put in. I have a ton of more information but I will try to keep this short as possible. Please, can someone help me? The doctors say its a mystery. No one can figure out why she is in this state since all tests come back normal. They are afraid she is becoming septic because her blood pressure started dropping. They now have her on meds to increase her blood pressure. Her sugar is also no elevated. They said it is due to the nutrients she is receiving via nasal feeding tube. If you have any questions, please ask. I will supply all information I know in an effort to solve this medical mystery.

[NormaJean1964]

Thank you so much Dr. Srivastava. We do have a neurologist researching the matter. I will ask about the above conditions to see if they have been explored. They have run countless tests and all come back as normal. The doctors are continuing to research. They are as baffled as I am. They started her on steroids yesterday. Right now it is wait and see if that helps.

[Dr. A. Srivastava]

Thank you for your question. Although without being able to placing her findings in context with clinical features and the results of other investigation such as hematological, MRI, I can not offer the specific advice & treatment she needs. However, I will try to provide you some relevant information about her health concern.

Since her reports suggest that it is white matter disease due to micro-vascicular ischemic changes and that could be reason of her symptoms. In white matter disease there is pathology associated with the brain white matter, either exclusively or in combination with grey matter changes. It occurs due to metabolism errors, exogenous toxins released by virus, autoimmune disease, leukodystrophy, demyelination, and radiation effects. Spasticity, muscle weakness, paralysis, hyper-reflexia and movement disorder may be the clinical features associated with white matter disease that need to be evaluated thoroughly. However, it is sad to say that there is no permanent cure but conservative treatment & physiotherapy exercises that would help you to regain your normal function and stopping the further progression of the disease. Please consult a neurologist in this regards. Hope this helps.

[ggreg]

Well, the white spots on the brain in the scan can be linked to stroke, whether it's the one she had before or another one.  She could be in a coma as a result of the first or possible second stroke.  You can get a consult with a neurologist outside the hospital to have a look at her pictures and give you advice.  Infection can cause coma, and sounds like your mother had quite the bladder infection going on.  I assume she is being kept hydrated NOW via her I.V. fluids, so once antibiotics clear up infection, it could be that by staying hydrated, she won't get another infection.  If infection caused her coma, she should come out of it, usually comas can last a couple weeks.  That's about all I know.