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mother's health


Sent to Health Experts July 05, 2006 9:31 a.m.
My mother is 77, has definite memory loss (short term), and her neurologist described the results of the brain MRI she ordered from my mother like this: "This shows decreased brain size.....I cannot understand this doctors written analysis, and I don't accept any MRI disc or film by mail, so if you want to go to the hospital and bring the originals to me, I will see you in four months.   And since the aricept is working (10 mg/day), I want to add Namenda, as studies show they work really well together. This combination will keep you as well as possible for as long as possible."

My mother had an incident which greatly concerned me. last Thursday. She got up from a slide presentation we watched, and could not balance herself or move herself forward without leaning to the right and losing her balance. I helped her out of the room,and very slowly down the hall, holding her arm for balance, and she went to the bathroom, and needed to lean against the sink for a couple of minutes, to regain her composure. (Actually, I think she did nothing in the bathroom, but she had time to recompose herself). She had some involuntary stomach wretching "convulsions" she called them, and said she felt nauseous. She was very very pale, looked very disoriented, and I sat her on the bench, got the car, got her home and into bed, and she slept for a couple of hours, felt "wiped out" afterwards, fatigued, and still a little queasy. I looked up on the interned for symptoms of stroke, and she said the only one she felt was the loss of balance. She also tends to minimize pain, sickness, etc.

Would a brain MRI show damange over time from previous mini strokes, if she were having them?????? And what does "decreased brain size" indicate????? Tina

Customer (name blocked for privacy)
Status: Closed   Value: $30   
Answer
July 05, 2006 10:10 a.m. (39 minutes and 25 seconds later) 		ACCEPTED Check Mark
I understand your concern, and it seems that you have a few questions here.

To answer, first, your directly stated questions - yes, an MRI will often show damage over time from small "mini-strokes" or infarcts, so long as they are large enough for the scan to show (all scans have limitations on the size of things that they can show, commonly a few millimiters or so).

Decreased brain size (brain atrophy) is a common finding on MRIs in the elderly - over time, as we age, our brains can normally shrink a bit. But this can also be a sign of Alzheimer's disease (AD) or dementia. The distinction depends on the pattern of shrinking - AD will often lead to atrophy in certain regions initially, and then become more global. Without more information, this could either be a normal finding (related to aging) or related to Alzheimer's disease or dementia.

Although it is really impossible to say what happened to your mother with any certainty the other day, from your description it sounds a bit like an episode of something called "vasovagal syncope" (VS) or perhaps a brief, blood-pressure problem called "orthostatic hypotension" (OH). VS can occur in people for unknown reasons, but leads to a decrease in blood pressure, a feeling of "fainting", and can lead also to GI complaints like you describe (nausea) and fatigue. In essence, VS causes a transient drop in blood pressure that leads to these symptoms. Similarly, OH can also can a transient drop in blood pressure (this is related to a quick change in posture, such as rising quickly from a seated position after being seated for a long time).

Many episodes of VS and OH are caused by unknown factors, but can be affected by certain medications (like Namenda, for instance), a decrease in fluid or food intake, a hot environment, or other factors.

So, from your description, it doesn't sound like your mother suffered a stroke at that time, or a "mini-stroke", but instead had an episode of VS or OH (I think OH is more likely, because VS is most often triggered by a trip to the bathroom, or other types of "straining", like coughing, etc., and it doesn't sound like your mother was exerting herself at the time). She could have been effected by the medication, or had decreased food/fluid intake, that led to a transient drop in blood pressure, which then led to her symptoms.

So, from your description, it doesn't sound like a stroke. But these "syncopal" episodes (fainting) can also be caused by irregular heart rhythms, transient mini-strokes (transient ischemic attacks), and other issues, so she should be seen as soon as possible by her physician. Describe the episode to them, and they will be able to perform a thorough exam and order whatever testing is appropriate.

I hope this helps. Please let me know if you have any further questions - I'm more than happy to try and help. Take care - Dr. Fay

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PictureJonathan Fay, M.D.  -- Doctor (MD) -- 100% Positive Feedback on 533 Health Accepts
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