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Avatar universal

Not a stroke but... what?

Patient is a 50 y/o F, Cauc, Non-Smkr, No Rx abuse, No alc abuse, BP elevated to as high as 240/170, now semi-controlled w/alpha-1 and beta (Labetalol) + 100mg Lopressor BID. Hist of CA's (BC, Thyroid, Skin-Basels, Hodgkins).  Becomes severely disoriented, confused, detached, and virtually catatonic with High BP onset (full recovery in approx 1hr after Normodyne Trandate push).  Onset seems to be having a lower threshold (@170/110 this PM) as time continues.  Experiencing on-going muscle weakness, imbalance, and numbness on one side (Left side of RH person).  CT = Neg, MRI = Neg, Ultrasound = 0-30% of carotid, EEG = Norm, Electro-cardio = Norm, Chem7 = Norm, LP CSF = Neg/Norm.  No HX in family of HBP.  Currently testing for pheochromocytes. K level exact mid-line @ 4.3 mEq/L.  Stroke has been R/O
Thoughts?
3 Responses
Avatar universal
Sounds like this person has really had a hard time of it.  You list a lot of problems here, but you don't list any treatments or diagnoses that have been suspected and rejected by the tests.  I also don't see any searching to find out WHY the high blood pressure is happening.  Is the HTN (hypertension or high blood pressure)  primary or secondary to another problem?  HTN is caused by problems with the kidneys, heart, lungs, or brain trauma, among others.  Have any tests been do to decide where the problems are that are causing the HTN?  Treatments of the symptoms are fine as far as they go, but treatment is never totally effective without finding the root cause of the problem.  You can see a nephrologist to check kidney function to see if the problems are rooted there, a pneumoneurologist to see if the problems are related to lung problems or brain trauma, and a cardiologist to see if the problems are rooted with the heart.  The treating Endocrinologist (for Thyroid) should also be able to test for problems relating to the Thyroid that may be contributing, or check for Diabetes to see if the patient is borderline with contributing vascular irregularities.  Find the root cause and adjust treatments and then you may see a good improvement.

This person also must absolutely get some aerobic exercise, even if it is mildly aerobic. This will help with muscles and will make the person feel better and fight depression and exhaustion.  Just sitting around and being weak and exhausted isn't going to help.  They need to contribute to their own healing by DOING something for themselves and their bodies.  Physical exercise will give them strength and help to ward off exhaustion and depression.  Walking, even up and down the hallway in the house for 20 minutes/3 times a day can be effective.  Sitting in a chair and doing leg lifts or reverse crunchies and deep belly breathing is helpful.  Work the upper body using a can of beans or soup  as a weight.  Exercise will make endorphins to cheer the patient up and make the body and mental outlook better.  Don't just lay around and complain about being weak and exhausted, but  and go outside for at least 15-30 minutes each and every day.  The sun helps the body develop vitamin D for healthy bones and will also help to fight depression.  You can go out during the warmest part of the day.  If it is just too cold, sit them near a window where the sun is shining in and let them get some sunshine that way for an hour or longer.  good luck
Avatar universal
Thanks for your input...
Patient was walking up to 6 miles per day only 10 days prior to this hypertensive attack.  All tests have now been reported and recorded and all are negative/normal.  Tests included MRI, CT Scan, LP/CSF, Ultrasound of neck, X-ray of head/neck/chest, EEG, cardiogram, 24 hr. urine for catecholamines, chem 20, Thyroid problems could be ruled out since the patient had a thyroidectomy (actually two partials = whole 30 months apart) following a primary and secondary dx of thyroid cancer.  Currently taking 125 mcg/uid.  Patient also had a TAH/BSO in June '07.  Neurologists, nephrologists, hematologists, oncologists, endocrinologists, and cardiologists have all been perplexed and unable to determine a root cause of the hypetension.  
This patient has *never* been one to lay around and complain about anything star queen.  Quite the contrary, considering hx, she has been the epitome of positive mental attitude and upbeat optimism.  
Final resolution before discharge was rx of 100 mg. metprolol B.I.D + 325 mg ASA enteric U.I.D.  Left arm/leg weakness expected to resolve 100% with P.T. instruction.
Avatar universal
I did not mean to imply that the patient was not physically fit, only that when people get ill such as this one is, they often are too weak or tired to resume exercise, but instead tend to "rest" too much and make themselves even more tired.  It is important to do whatever they can to resume as normal a lifestyle as possible.  This person has really been through the mill and I am surprised that antidepressants haven't been added to the regime of meds.  A test I do suggest is a tread test with a PET scan in nuclear medicine.  The patient can either do the actually physical tread mill, or do a chemical treadmill and see how the heart is really doing to absolutely rule out heart problems and any blood pressure and pneumohypertension.  The patient can also see a urologist to test the kidneys for stones or other problems related to hypertension because of kidney malfunction.

I am also wondering if menopause may be a contributing factor.  Often women either in menopause, or just post menopausal will develop anxiety that will actually give them hypertension.  The patient will not actually have hypertension, but anxiety can raise the blood pressure to the point it is considered hypertension and meds are prescribed.  With proper hormonal support the hypertension will return to normal on it's own. I have a friend in her 50s who underwent a thyroidectomy and suffers from severe anxiety as a result.  She takes 300mg of the herbal supplement Black Cohosh every morning. It balances her hormones, reduces her anxiety and blood pressure.  She no longer takes blood pressure or anxiety medications.   A simple blood test for female hormones will tell her how she is doing in that catagory and she can discuss the addition of the herbs with her physician.  Herbs don't always work for everyone, but Black Cohosh very rarely interacts badly with prescription medications.  It may or may not work, but it won't hurt her to try (with doctor's permission).  She should try it for at least a month before giving up on it.  good luck
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