Skip to main content

Some other interesting stuff...

I recently ran across this stuff: the first is from Dr. Piper who performed my craniotomy and my stroke surgeries; the second is the impression of the radiologist from my CT scan pre-surgery, and the second is from the first post-surgery CT. Interesting stuff:

ADMISSION DATE: 12/10/2008

CHIEF COMPLAINT: Bilateral cerebellar infarction

HISTORY OF PRESENT ILLNESS: The patient was sent over emergently from the VA by the neurologist. He apparently a couple weeks ago had a cold and was treating himself with cold symptom medications. There is also one report that he had undergone chiropractic manipulation but apparently talking with family it was not a chiropractor it was just a massage therapist and there was really no substantial manipulation of his neck. Regardless, two nights ago he said he really did not feel well at all and went to bed. He woke up at 1:00 in the morning and had significant vertigo, headache and nausea and vomiting so they did ultimately take him into the emergency room. A head computerized axial tomography scan at that time was negative. They did do a lumbar puncture to make sure he did not have any signs or symptoms of infection given the history of cold symptoms which apparently by report was negative. He was sent to the VA for further evaluation. Subsequently he has been diagnosed with cerebellar infarctions based on computerized axial tomography scans and magnetic resonance imaging scans that were performed and fortunately these are bilateral and they appear to involve the pica distribution. However the concerning things is apparently the patient yesterday was wide awake and lucid and today progressively over the day has become significantly more lethargic and developed bilateral extraocular motility defects. Because of this, they obtained a scan which shows early hydrocephalus as well as significant posterior fossa swelling.

PHYSICAL EXAMINATION

GENERAL: He is a very lethargic patient that will arouse with stimulation. He will answer a few questions with simple yes and no answers but it sounds like he has significantly gone downhill even over the last several hours.

NEUROLOGIC: He has extraocular motility that is very hard to characterize but I do think it looks like interocular ophthalmoplegia or perhaps polycranial nerve involvement but clearly abnormal. His pupils are small and remain perhaps minimally reactive. He does seem to have diminished gag response. He does move his extremities but it is hard to get a detailed examination but Babinski is present bilaterally on exam. Gait and station were not tested.

CARDIOVASCULAR: Regular rate and rhythm.

LUNGS: Appear to be clear but the breath sound are somewhat diminished

IMPRESSION: This gentleman has the above mentioned problems. I have had a chance to look at the films. I have reviewed them with our radiologist. Initially the films were not available but they did finally show up from the VA. In the interim, since we really did not know exactly what was going on we did get a computerized axial tomography scan so we have been able to compare this. It looks like he has got fairly extensive pica infarcts of the bilateral cerebellar hemispheres. Because of this, I think we will plan doing a midline decompression in light of his deterioration where we will try to do stroke resection bilaterally and patch the dura as best we can to give it room for swelling. The patient also probably would benefit from an external ventricular drain at lest in the short-term given the significant problem that he has. I was fairly frank with the family that obviously surgery is not going to change his overall course with respect to the stroke. He will still have deficits from this even if he does survive. What surgery is is an attempt at saving his life because of the progressive swelling that he has developed and an the anticipation that this is heading downhill fast enough that he will die from the brain stem compression. They do understand that the stroke still may progress and he may be significantly disabled or even die despite doing surgery that surgery does have risks of infection, cerebrospinal fluid leakage that might require pseudomeningocele repair at a later date particularly since we may not be able to get watertight dura closure if there is significant swelling. We also did discuss the risk of intracranial hemorrhage, infection and they wished to proceed with surgical intervention.

John G. Piper, M.D.

CT HEAD WO CONTRAST

INDICATION: History of bilateral cerebellar infarcts

COMPARISON: There is no previous imaging for comparison

TECHNIQUE: 5 mm images of the brain were performed without intravenous contrast administration

FINDINGS: There are areas of decreased attenuation identified in the cerebellar hemispheres bilaterally. This may represent bilateral PICA infarcts. Other etiologies for vasogenic edema cannot be excluded. The previous imagining on this patient is not available for comparison. There is compromise of the fourth ventricle. Mild hydrocephalus is consistent with mass effect.

IMPRESSION: There are areas of decreased attenuation within the cerebellar hemispheres bilaterally. By history, these represent areas of infarctions on the previous MRI examination. That examination is not available for comparison.

CT HEAD WO CONTRAST: CRANIOTOMY FOLLOW-UP

FINDINGS: Head CT without contrast: a ventricular shunt catheter enters the right frontal region. Its tip projects near the midline in the right lateral ventricle. The ventricles are within normal limits in size. There is no evidence of focal cerebral abnormality or hemorrhage. Postoperative changes present in the posterior fossa. Regions of increased density and air bubbles are present centrally within both cerebellar hemispheres. The occipital craniectomy has been performed.

IMPRESSION: Postoperative Change. Apparent bilateral cerebellar resection sites are present. Air bubbles are present at both sites.

Comments

Popular posts from this blog

Does it get any worse than a stroke? Yes

On December 8, 2008, my life changed forever. I had a double sided cerebellar stroke with 2 brain stem compressions. It was not until December 10, 40 hours after my stroke, that surgery was finally done to relieve the pressure. Dr. Piper, the neuro-surgeon from Iowa Methodist hospital in Des Moines, told my wife that surgery was nothing more than an attempt to save my life, but that it would not erase the deficiencies as a result of the stroke. Although she admits that she did not really understand what Dr. Piper had just said, my wife, Laura, agreed to the surgery and the care team performed a decrompessive craniotomy, to hopefully relieve the pressure and allow my brain to function somewhat normally. For those who have followed my blog for the last 14+ years, the surgery was successful, I returned to the church and I now live a relatively normal life, although I do have some pretty severe, though not always visible, defieciencies. I really thought that life could not get any worse th

Sometimes I forget...and sometimes I just have a problem putting words together

It has been almost 15 years since my stroke, so you would think that, by now, I would be readily prepared for everything that life can throw my way; but, I often forget what it's like to have a simple head cold after my stroke. Now, understand, I am not suggesting that other people don't feel bad when they have a cold; it is just that it is different for a stroke survivor. Maybe some of the other stroke survivors feel the same way: many times when I get a head cold with the congestion, suffy nose, fever, etc., it begins to feel like I'm having a stroke again. For those who don't know what this is like, let me try to explain. I get up at night, whether to go to the bathroom or some other reason, and I feel completely disoriented for a few seconds. Not like I'm groggy, but that I feel the room is spinning, I can't tell which direction I am going, I forget where the bathroom is for an instant, things like that. On the first day of this last cold, I was going down

It's amazing what you can learn from a 2 year old...

Ok, to be fair, he is closer to 3 than he is 2, but either way, shouldn't I be the one teaching him lessons instead of the other way around? I'm talking, of course, about our grandson, Theo. He came to stay with grandma and grandpa last night, and let's just say that he seemingly never gets tired! As tired as we get, we absolutely adore our only (for now) grandbaby. This morning, is when I learned a very valuable lesson from Theo, both as it applies to life after my stroke, and my life after the loss of my only son, Brendan. Picture it, Sicily, 1924...wait, where did the Golden Girls reference come from? Maybe I should just go back and erase it, but, I probably won't. In fact, the fact you are reading this means I did not...Anyway, picture it, we are oustide this morning; it is a pretty chilly morning, there is some frost on the car windows, we can see our breath, and Theo is watching the dogs play in our backyard. And then he spots it: his "bike." He runs ov