Is it "evolution of stroke" from minor, acute, and now severe ischemic stroke???

[gduong]

Dear Dr.

My mom (at 80 yrs old) has high blood pressure (~160 on avg.) suffered a stroke 3 weeks ago. When she was admitted to our local hospital, my mom could still managed to stand and walk. The first diagnostic by the ER doctor confirmed that she has suffered a minor stroke, but no treatment was done.

When my mom moved to the temporary assessment unit, she suffered an acute ischemic stroke based on review of further CT scan, but no change to the original treatment is made.

Recently, from more severe headache (while she is in rehab), we were now advised that she now has a "severe" ischemic stroke, has a " huge hole" in her right brain, but this is normal in the evolution of stroke. Her doctor then told us to goggle "hygroma." Is this right? Please advise what we need to do inorder to ensure that my mom is being treated properly. We are losing sleep and faith! Any helpful advice would be much appreciated.

[Dr. Joshua]

Without seeing the pictures and examining her, it's hard to say. She is 80, which reduces treatment options and worsens the prognosis.

Treatment of ischemic stroke usually is mainly supportive, and trying to prevent further strokes. Causes are determined. For instance, in a case where there are multiple strokes within a short time span, and especially in elderly patients, there may be an underlying cardiac arrythmia, which is diagnosed and treated, and often blood thinners (anticoagulants) are initiated at a suitable point in time.

Statins and aspirin are usually started after the first stroke. This is called tertiary prevention -> prevention of further strokes when a stroke has already occurred.

There is little that can be done to the stroke that's already there, apart from minimizing its damage by controlling blood pressure and ensuring proper ventilation, fluid balance and so on. Life-saving neurosurgical procedures are sometimes needed in young patients with massive strokes.

These are just general thoughts, unfortunately I cannot comment on your mother's specific case because I don't have the benefit of examining her and seeing her CT scans.

Please do pose these questions to the attending neurologist - he/she should be able to provide you with satisfactory answers.

Treatment is of course individually tailored.

[gduong]

Dear Dr. Joshua,

Many thanks for your prompt and informative reply!

I will follow up with my mom's neurologist. Eventhough, we have not been told of my mom's embolic stroke. We suspect that it be due to her irregular heart beat.

We are just curious if there has been an effective way for her physicians to reduce the pressure or swolleness from her ischemic stroke to reduce the damaged area.

I will send her scans soon.

Best regards,
Gloria

[Dr. Joshua]

Thanks, keep us posted