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Suggest Treatment For Recurrent Transient Ischemic Attacks Due To Atherosclerosis

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Posted on Thu, 31 Aug 2017
Question: Im online on behalf of my mother, 83, had cartoid stent (reverse flow) in XXXXXXX Has been passing out cold; left hand and arm sometimes feel completely dead. Yesterday slurred speech and then no speech for about 20 minutes but her brain knew what was going on. Has prothrombin gene mutation and her blood pressure is all over the place. When she sits or stands her blood pressure drops to dangerously low levels. She is weak and has been bedridden for the last 3 weeks and her nerves are shot (she suffers from PTSD due to car accident and also from death of husband 6 months later, death of son 7 years later). I don't know how to help her be calm enough to eat and build her strength back up. Help?

Here is a list of medications taken:

Depakote
Synthroid
Plavix
Midodrine (not sure if spelling is right..its to keep blood pressure up when she stands or sits up)
lipitor
warfarin
probiotics
remeron
ativan
equus stool softener
doctor
Answered by Dr. Neeraj Kumar (1 hour later)
Brief Answer:
Get examined and investigated by a neurologist

Detailed Answer:
Hello,
I have gone through your question and understand your concern.
She is having recurrent transient ischaemic attack due to atherosclerosis.
Postural hypotension is another contributor to this problem.
The medications are according to recommendation and fine.
Detailed cardiac evaluation and aortogram may be done to look for any other cause of recurrent thromboembolism.
Pressure stocking for postural hypotension can be added.
Physiotherapy plays an important role in this situation.
Autonomic function testing should be planned after consultation with a neurologist.
Examination by a neurologist will help in identifying any other cause of autonomic dysfunction.
Hope you found the answer helpful.
Do get back to me for further information.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Neeraj Kumar (15 hours later)
She has had numerous ct scans and mri's each time she has passed out. They have ruled out tia's. The hospital is currently trying to get her blood pressure under control but it continues to go from low to high. I've mentioned to the docs that her blood pressure goes low when she stands or sits, and she sometimes passes out. When she wakes up she is so nervous her blood pressure sky rockets.

She has a neck problem I know because it hurts her all the time and sometimes when she turns her head you can hear it snap 2 seats away from her.

She wears pressure stockings.

Im wondering if the midodrine isn't being cancelled out by the Ativan and Remeron. She has no appetite and a balanced, constant diet is necessary...do you think she should be given an appetite inducing med?

She is highly sensitive to cold and is constipated all the time. Is this from the Synthroid?

Is the Plavix and Warfarin overdoing her blood thinning?

The doctors don't seem to know what to do and obviously neither do we. Should she just go back to the meds she was taking before the surgery (warafrin, remeron, synthroid). I'm afraid she will be released from the hospital into a nursing home where she will be given heavy sedation and eventually I'll get a call about hospice. She was a vibrant woman a couple of years ago, taking care of horses, a home, driving, etc....she has been reduced to a weakened body with a good mind and strong heart.
doctor
Answered by Dr. Neeraj Kumar (19 hours later)
Brief Answer:
Continue treatment as advised

Detailed Answer:
Hello,
Wide fluctuations in blood pressure can occur due to pheochromocytoma.
Postural hypotension needs to be managed as advised to avoid such loss of consciousness.
Drug interactions between ativan or midodrine is not significant.
There is no problem with warfarin and clopidogrel too.
Hypothyroidism causes constipation and synthyroid helps in improving constipation.
You can add cyproheptadine for increasing appetite.
Depression should be ruled out too.
Wishing her good health and early recovery.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2259 Questions

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Suggest Treatment For Recurrent Transient Ischemic Attacks Due To Atherosclerosis

Brief Answer: Get examined and investigated by a neurologist Detailed Answer: Hello, I have gone through your question and understand your concern. She is having recurrent transient ischaemic attack due to atherosclerosis. Postural hypotension is another contributor to this problem. The medications are according to recommendation and fine. Detailed cardiac evaluation and aortogram may be done to look for any other cause of recurrent thromboembolism. Pressure stocking for postural hypotension can be added. Physiotherapy plays an important role in this situation. Autonomic function testing should be planned after consultation with a neurologist. Examination by a neurologist will help in identifying any other cause of autonomic dysfunction. Hope you found the answer helpful. Do get back to me for further information. Regards Dr N Kumar Neurologist