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Stroke

Bilateral lacunar infarcts, both globus pilla

08/24/2007

Question:

Medical History: High Blood Pressure, Diabetic, Heart Attack, Heart Surgery, Sinus Problem, Gastric Problem (acidity) Alergic to Iodine

My Dad, had heart attack 2 years before the heart surgery on May30th 2007. After the surgery of 10 days he went to home. Doc gave him insulin to control his suger level. they had given him 20 in the morning 40 unit at night. they said it won`t be matter if his suger is low or high just take the insulin unit as it instructed. So he was taking insulin as the doc told. everyday he wakes up with low suger in 4 days row. so i had to consult with a surgeon and they lower the unit of insuline, same thing happen his suger still was going to lower level. so on June 6th 2007, his suger went down completely to "0" he was unconsciouse and didn`t had sense at all. we called 911 to take him to the hospital. I put some sugar in his mouth so he came to sense and was able to talk. then 911 ppl took him to the hospital, on the next day they did a cath scan to see if that has been affected my dad`s brain. on

June 10th 2007. the report reads follows.

Reason for Exam: LOC Read: CT scan of the brain without contrast Clinical history : Loss of consciousness

Midline structures are normally positioned. the ventricles are nomal in size and contour there is no hemorrhage. No Extra-axial fluid collections are noted.

Impression: Negative Study.

After that he came home again, this time he doesn`t feel energetic to talk, don`t complain about anything. all he does watching TV. whole day and night. he prays too, and eat while my mom give him food. never complains about anything. He can`t hear well. before the sugery he always a active person. so i complained to physician why this problem involving, so the doc gave him some test to do. Eye exam, CT scan, Dentist, Blood test. So now his eye exam result says he has Double Vision, Dentist not bean done yet. Blood test normal. Heart is ok. CT Scan report are as Follows.

August 9th 2007

Reason for Exam: Memory Loss Read: CT brain without contrast Clinical history: memory loss Comparison: 06/10/07

Finding: Since prior examination, the patient has developed Bilateral Lacunar Infarcts Within Both Globus Pilladi. This appears to be more chronic on the left then right. Further evaluation with an MRI may be helpful. There is no evidence of Hemorrhage or Extra-axial fluid collection or hydrocephalus. No other adnormalities noted.

IMPERSSION: The patient has developed Bilateral Globus Pallidi Infarcts when compared to 06/10/07 report. Further evaluation with a image magnetic resonance imaging is suggested.

Now you can see the difference view of the June and August report after his surgery.

Now can you please tell me the following.

1. what is Bilateral Lacunar Infarcts Within Both Globus Pilladi? 2. from the histrocal point do you think this (Bilateral Lacunar Infarcts Within Both Globus Pilladi) happend from the heart surgery or the unconciousness? 3. is there any cure of Bilateral Lacunar Infarcts Within Both Globus Pilladi?? 4. When cell dies in the brain does this affect any other brain cells? 5.is this a major strok that can kill a person slowly?

Please explain me the details as i have described the situation and medical history of my dad. I am waiting for reponse. I appreciate your time and concerns.

Thank You in advance!

Answer:

It is not possible for me to fully answer your question, specific to your father, since I cannot do a full history and physical exam. I will make a few general comments which hopefully you will find helpful, and which you may discuss with your local physicians who know him best and can fully evaluate him.

The globus pallidus is a deep brain structure, present within both hemispheres. It functions to aid in proper movements, although lesions in this structure are not typically associated with problems in hearing or double vision. It is not possible to say with certainty what caused the lesions. A CT scan is not the best brain scan available, and one wonders if the lesions were present on the first CT but not mentioned in the report or not. If not present, it would seem that the lesions developed after both the cardiac surgery and low glucose events had resolved, so it is hard to blame either event for the lesions.

Lacunar infarct refers to small strokes involving the globus pallidus on each side of the brain. I have previously written about what a stroke is, and what a lacunar stroke is, and I refer you to previously answered questions within this Netwellness section for more information. A stroke is an event that occurs, leaving permanent brain injury. Recovery can occur after any stroke, and typically occurs over weeks to months. Patients tend to reach a plateau, but current thinking is that recovery can continue indefinitely.

Once a stroke has occurred, it is necessary to do all that is possible to lessen future risk for stroke. Again, I refer you to previously answered questions about “Stroke prevention”.

A final thought, given your description of your father’s behavior. Major depression is a very common problem after a stroke, and is treatable with medications. It would be worth discussing this possible diagnosis with your local physicians.

For more information:

Go to the Stroke health topic, where you can:

Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati