Input 1

On Tue, Feb 14, 2012 at 4:11 PM, Prodip kar ( Social Worker) wrote:

Bengali: Kaal Ratre theka amar patient jinni ekjon 80 bochorer purursh, kaemon durbal hoya gaechaen. Beshi kotha bolchen na. 14-02-12 local dathar dakhano hoycha tar tekat ta satha deyadelam kentu ja osudgole diyechae segulo khawale bomi hocche. Aekhon ki korbo?

English: My patient a 80 year old man suddenly feels very weak and mute and after showing him to a local physician who prescribed medications he has started vomiting. What should I do?

 

Output 1

From: UDHC physician
Date: Tue, Feb 14, 2012 at 4:55 PM

Bengali: Unar stroke (brain attack) hoye thakte pare. Aro details (clinical examination) ae bojha jabe. Apnar local daktar unake bomir jonye Tablet Avomine diye dekhte paren. Nahole injection dite habe. Unar blood pressure kerokom? CT head korte hote pare. rakesh

English: He may have had a brain attack (stroke). More details may be ascertained from clinical examination. Your local physician may try Tablet Avomine for vomiting otherwise he may require iv medication. How is his BP? He may require a CT head. rakesh

From: Rakesh Biswas
Sent: Wed, 15 Feb 2012 21:14:44
To: Physician Teacher <***@gmail.com>
Subject: Re: CT of an elderly man with sudden altered sensorium

This 80 year old patient's son has sent these CT images from a rural remote location in North Bengal. The patient is still in altered sensorium although slightly less delirious. Any comments particularly on the age of the hematoma will be appreciated. What should be the next step in management?

regards, rakesh

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From: Rakesh Biswas
Sent: Wed, 15 Feb 2012 23:11:55

Thanks!

They managed to go to the nearest town (120 kms) to get the CT head but didn't have money to get the hematoma evacuated. So they are back at their rural remote location currently on 'medical' management.

regards, rakesh

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From: Rakesh Biswas
Date: Thu, Feb 16, 2012 at 11:05 PM
Subject: re: CT of an elderly man with sudden altered sensorium
To: Physician Teacher


Thanks for this valuable information. This patient is however 80 years old and his family made a conscious decision to take care of him at home (the private practitioner/neurosurgeon provided an estimate of a cost somewhere around 1 lakh for the surgery and 1 more lakh if he couldn't recover soon and had to be kept on a ventilator etc). He seems to have recovered to almost near normal sensorium and has started eating with support (without any treatment). All his children are currently at his bedside.

I agree whatever medical management of this condition described in the literature (there is surprisingly some documentation of it: http://www.ijntonline.com/June09/abstracts/13.PDF, https://ssl-w03dnn0374.websiteseguro.com/sbn-neurocirurgia/site/download/artigos/article.pdf) can be best described as supportive if not just placebo therapy or even spontaneous recovery.

Ravi, I was wondering if i can conclude from my reading of this link http://emedicine.medscape.com/article/344482-overview#a20 that the CT of our patient suggests an acute hemorrhage into a chronic collection? I wonder if the chronic subdural hematomas we see in the community

are just a tip of the iceberg who manifest symptoms and there may be more spontaneous recoveries than we know?

regards, rakesh

Update on Mid 2013: Currently complains of:

Chronic headache, Day time Hypersomnolence, Insomnia, dementia, nocturnal urinary incontinence as evidenced by reading the hand written letter of the patient's relative.See hand written letter pasted below:

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