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What Causes Constant Headache In The Mornings And Memory Loss?

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Posted on Fri, 16 Jan 2015
Question: Hello,
Please forward this question to "Dr. XXXXXXX K NATH" ONLY.

Cause: Loss of memory and awareness, Patient is currently in ICU.
Expectation: Various diagnosis and solution from your end, please help with supporting facts.

History:
My Dad is 62 years old. He is a retired government employee. From past 2 years, he is at home and has been leading sedentary lifestyle. He is diabetic since 26 years and He has blood pressure since 10 years. He is using insulin injections since 15 years. We started seeing kidney anomalies since 5-6 years. The creatinine, urea levels started rising above normal range since 1 year. We started the dialysis since October 13, 2014 because his legs were swollen, was vomiting and he had severe itching almost all over the body. At first, dialysis was 3 times a week and now it is 2 times a week. The AV fistula is done on his left hand. There was no significant decrease in urea level even after the dialysis process. His urea level had always been around 65-80.

After the dialysis was started, for 1.5 months, though he lost 15 kgs, he was fine. He was on high protein diet and occasionally used to vomit. He often mentioned that he does NOT have much strength in his legs, it is difficult for him to get up from chair or walk for long distance. He did not mention about imbalance but only mentioned of lack of strength.

Recent symptoms:(past 15 - 20) days
-> he gets headache occasionally, usually when he wakes up.
-> He has got herpes on his left leg since 7th December and it has spread a little to his left buttock and to the right ankle. It is bit doubtful that it is on his buttock because it is difficult to differentiate between itching marks and blisters.
-> Since 20 days month there were few times, when he wakes from the nap/sleep, he had no idea, where he is and he used to forget where is the kitchen, bathroom. He was able to recall once we explain. This memory loss condition lasted only for few minutes and it was intermittent. He has fallen down couple of times while getting out of the bed or the chair and this may have happened because of imbalance rather than the lack of strength in his legs.
-> On 13th December the memory loss got way to severe he used to forget once every 5 minutes. This time, the condition lasted for more than 8 hours and his sugar levels were high so we took him to the doctor.
-> Sugar levels 400 on 11th December and 554 on 13th December. Blood pressure 160, Urea 110, Creatinine 6.5.
-> There has been no fever recently
-> There has been no frequent vomiting recently.
-> He has never wet the bed and always knew whenever he wants to urinate and went to the bath room.

Initial treatment:
The doctor said the memory loss condition might have happened because of high sugar level (500). We got him admitted and his sugar levels were brought down but there was no improvement on the memory part and it was getting worse. On 14th December, the doctor recommended a different hospital and adviced to consult a neuro surgeon as his condition was deteriorating. On 14th December evening, my dad was admitted to MICU with ventilator as he was not opening his eyes and was not responding to our words. He was reacting to the pain, move his hands but he was not self aware.

The treatment that has been done so far is mentioned in the link mentioned at the end of this page. The reports includes clinical summary, all tests results, X-ray result, MRI CD and report.

Important questions needs to be answered:
1) Doctors are planning to drain the liquid from brain. Will therapeutic lumbar puncture / EVD help my dad to wake up and open his eyes? What is the life risk involved in this procedure ?
2) Please let me know if you know any other procedures.

Thanks in advance!

Note : Patient name and hospital name has been intentionally kept anonymous.

Steps to access the reports:
1) The reports are available at the link https://drive.google.com/file/d/0B9UwHj2KKh0gVEJhQjJrVTFjZWs/view?usp=sharing
2) Before opening the "All in one" folder, please download it first by clicking the "down arrow" button at the top.
3) After downloading, extract using winzip and winrar
4) To access MRI film, please open "MRI CD" folder and open "Autorun.exe"
doctor
Answered by Dr. Praveen K Nath (14 hours later)
Brief Answer:
STROKE + METABOLIC DERANGEMENTS CAUSING DECREASE SENSORIUM

Detailed Answer:
DEAR MR XXXXXXX
HELLO
I have gone through your father’s detailed medical history & investigations.
Thanks for submitting everything in detail.

1. Your father,s condition seems to have deteriorated mainly due to stroke with right PT infarct / left parasagittal frontal infarct with petechial hemorrhages & metabolic derangements due to diabetes & renal impairments .

2. In my view his condition is unlikely to improve after CSF drainage as ventriculomegaly seems to be secondary to cerebral atrophy ( ex evacuo hydrocephalus )

3 Possibility of herpetic infection of brain is always there, hence one should continue with ACIVIR therapy

4 One should manage DIABETES/ RENAL FAILURE / CHEST INFECTION etc vigorously to get optimum results

5 Maintain proper oxygenation levels with ventilation etc. Later tracheostomy & gradual weaning off ventilator as per neurological recovery is suggested.

6 NO any surgical procedure for managing these problems. Treatment remains same throughout country as per protocols. Hence continue treatment under expert supervision of a neurologist/neurosurgeon /physician/nephrologist & intensivist

Hope this answers your queries
Feel free to contact me any time for any future queries
My best wishes for your father’s complete & speedy recovery

Thanks

Dr XXXXXXX k XXXXXXX
Director
Dep’t. Of neurosurgery

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
Answered by
Dr.
Dr. Praveen K Nath

Neurologist, Surgical

Practicing since :1996

Answered : 147 Questions

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What Causes Constant Headache In The Mornings And Memory Loss?

Brief Answer: STROKE + METABOLIC DERANGEMENTS CAUSING DECREASE SENSORIUM Detailed Answer: DEAR MR XXXXXXX HELLO I have gone through your father’s detailed medical history & investigations. Thanks for submitting everything in detail. 1. Your father,s condition seems to have deteriorated mainly due to stroke with right PT infarct / left parasagittal frontal infarct with petechial hemorrhages & metabolic derangements due to diabetes & renal impairments . 2. In my view his condition is unlikely to improve after CSF drainage as ventriculomegaly seems to be secondary to cerebral atrophy ( ex evacuo hydrocephalus ) 3 Possibility of herpetic infection of brain is always there, hence one should continue with ACIVIR therapy 4 One should manage DIABETES/ RENAL FAILURE / CHEST INFECTION etc vigorously to get optimum results 5 Maintain proper oxygenation levels with ventilation etc. Later tracheostomy & gradual weaning off ventilator as per neurological recovery is suggested. 6 NO any surgical procedure for managing these problems. Treatment remains same throughout country as per protocols. Hence continue treatment under expert supervision of a neurologist/neurosurgeon /physician/nephrologist & intensivist Hope this answers your queries Feel free to contact me any time for any future queries My best wishes for your father’s complete & speedy recovery Thanks Dr XXXXXXX k XXXXXXX Director Dep’t. Of neurosurgery