Ischemic strokes: State of the art hospital or the tale of a not so professional medical approach

[alyx]

Bear with me as this is a bit of a long story which started on 2012, July the 20th when I woke up at 7am to find my spouse, Thai of 42 y.o.a at the time, staring at me unable to speak. I thought it was fatigue so I went to work but came back, out of worry, a couple of hours later to find him wandering in the hall, unable to open the door ( digital lock), confused but luckily accompanied by some of the cleaning ladies of the building.

We went to the neighbouring,non profit, private hospital where we waited more than an hour the consultation with the Neuro who ordered a scan and some x rays which did not reveal anything. He dismissed the matter saying that recovery should not take that long and no special treatment was necessary apart from frolic acid. The Neuro then, wanted to investigate further, lumbar puncture and other blood analysis. By the time it was already 3 PM and, before the obvious distress in which my spouse was , I decided to refuse to go along and had him released from the hospital to drive him to see his family 200 km from Bangkok

By the way, although the staff was nice ( the same goes for all the hospitals we went to afterwards ) the bother is that one the questions asked in a recurrent manner was: are you sure he is Thai ? Why can't he speak? Quite stressful when one comes for help

Nevertheless, the following morning I called one of my acquaintances who happens to be a MD. He suspected a vascular stroke , adding that it was a bit late to act as there is only a three hour window to take action but further investigation would certainly help to determine the correct diagnosis as well as the cause. He directed me to a famous public hospital where the condition of my spouse was not recognised by the staff. We waited for an hour before learning that the neurological department was closed on week-ends,,,,, I called my contact who directed me to another ( private hospital ) where we met with a neurologist: panel of blood tests as well as an MRI. Of course I refused admission for my spouse as it was clear that he was just going to be ion observation until all the results would come back.....a week later ( some of them came back two months later ) Actually one of the nurses was quite upset about the fact I was getting the results the same evening but would not agree on an hospitalisation. The MRI confirmed a vasculopathy but all the tests, to define the origin of the stroke, came back negative. We had to go back to the hospital twice before the Neuro decided to give a treatment, 11 days later. By that time my spouse had aphasia ( unable to speak words but could read, out loud, and write again without any medication) Nothing else could be done

A month after that , in the evening he started to be confused but everything went back to "normal" an hour or so later. Worried that it would happen again I eventually search the internet and found a "great hospital" with the proper emergency services ( I also had called the first Neuro we had met to ask about the Neuro ER: there was none)

What was to happen, happened: early September 2012 my spouse felt his right side go numb, but it did subside within ten minutes. The following day, in the evening, he was in the gaze, with serious difficulties to walk. I took him to the hospital I had found on the web. They immediately treated him ( perfusion ). He stayed three days in the ER and thirteen days hospitalised. He had, during his stay, three more episodes leading to right side hemiplegia, but, each time recovering from it. I could not me more happy about the way they deald with the condition as I thought that they had saved him from a certain death or at least from paralysis

Until June 2013, some complaints about his leg or harm going numb where dismissed as tiredness by the physician who could not understand the reason of this happening especially because my spouse could understand better some conversations and speak isolated words

On 2013, June the 12th, his right side went totally numb. I drove him to the same hospital who took care of him. Upon the day of his release, on the following Saturday, at 9.30 am, my spouse suddenly acted like a broken doll. I "summoned" the doctors but was told that my physician would be available after noon. As I pay the bills I "delicately" insisted on having someone assessing my spouse ASAP. This was done and a scanner revealed a small stain on the brain but no course of action could be taken as an MRI was needed and could not be done before the evening.. I left the hospital two hours ( I had to go to the bank to withdraw cash for the hospital bills, as I paid on a daily basis...I don't like surprises ) and when I returned, I found him unable to move at all or utter a word .

He was rushed to the MRI. Some twenty minutes later I walked to the scan room to find a bunch of nurses frightened and powerless before my spouse: they had had to take him out of the room as he was yelling, crying having regained strength in all his members, unable to breathe regularly, his head slightly on the side and the eyes looking upwards, unable to hear nor understand anything. I held him, trying to calm him down but nothing could do. Eventually one of the nurses ordered a Valium injection which had no effects and even after a second injection he remained in a fit for approximately an hour . He recovered gradually but it took a while before he was able to recognise me. At this time, he has no recollection of the event.

He was treated adequately and released from the hospital a week later with a new treatment for the vasculopathy ( or , by now, called ischemic strokes, lack of oxygen in some part of the brain) in a good physical shape. The right side hemiplegia being consistent with the part of the brain attacked

As everything was fine, we decided to maintain our trip to Europe in August and had him assessed there. MRI and other tests did not reveal anything about the origin of the strokes. Early September, a mild numbness occurred twice in a day: I decided to take him to the ER where he was given saline water perfusion mixed with some vitamins. I was upset with the staff because they did not seem to be willing to intervene within the famous three hour window. The intern in charge explained to me that such a course was required when no amelioration was noticed but my spouse was recovering by himself. They eventually hospitalised him to conduct more exams ( which I thought useless as everything had already been done) but in the morning, against all expectations, the physician in charge with the ward, with her team, said that these were not ischemic strokes and the only thing to do was to let the patient recover by himself. Some minor changes to the treatment were made in order to prevent the episodes with further adjustment in case of a new episode.

Unfortunately since we came back he has had three episodes leaving him exhausted but recovering each time. The last one just happened this morning but is lasting longer than usual as his right side is going numb as soon as he is trying to walk some distance. Rest is in order of course and time will tell. But in the meanwhile, although the last hospital was good ( wouldn't he have recovered the same way if untreated is my main question actually ) I am searching for a good Neuro able to determine the real condition and adapt the treatment as I remain convinced that the last diagnostic made during our trip was correct

Although it is more about warning everyone about such situations when confronted to someone presenting the kind of symptoms cited above and also express my anger at the attitude of the first Neuro I met, that I do hold responsible for the untreated ischemic stroke ( would he have sent me to a proper ER, my spouse might have recovered, if not all, but at least partly from his condition ) added to my personal ignorance, I am posting to see if, maybe, someone could direct me to the right physician.

I haven't given any names nor explained the last diagnostic on purpose as it would not be fair to any hospitals as they have their bunch of good and not so good practicians, it goes without saying that I blame myself for my lack of reactivity as well as for the decisions I did not take because it was more convenient to go to the nearest hospital thinking they were all the same. I feel like I chose the wrong place at the wrong time

So if anyone has had the patience to read this through and has and idea......thanks ( I do apologise if what I wrote is not always clear or understandable but ...it is a long text )

Edited October 4, 2013 by alyx

[Sceptict11]

A complex and somewhat confused post.

All "strokes" are "vascular" but may be ischemic OR hemorrhagic

A CT or MRI scan differentiates the two and very different treatment options are available depending on identified cause.

This case is interesting in that it appears to span Thailand and Europe!

I am sure someone will be able to direct the OP to a neurologist but an indication of where the OP lives would be helpful.

[alyx]

We live in Bangkok

Of course, I am not expecting a diagnostic over that post, it is more a way to take a load off my chest as I am still upset about the approach of the first Neuro, not understanding either, why, in Thailand, the sensory and the motor loss have been dismissed as a corollary to the ischemic stroke, whereas I had a different answer ( and, in my opinion, sound, given the description of the "attacks" on his right side ) from a European physician team in less than 24 hours

I am not saying that neuros in Bangkok are bad, just trying to find the right one in order to prevent, or at least lessen the frequency, of the stressful events,

Also, I am worried that I will not be able to make the difference between another stoke and the motor loss, as I have decided not to rush him to the hospital whenever this happens, as the loss seems to subside anyway

Am I irresponsible?

By the way, thanks for your time

Edited October 5, 2013 by alyx

[Sheryl]

Bangkok Hospital is pretty much the leader in early management of stroke. Suggest either Dr. Surat Boonyakarnkul or Dr. Chanpong Tangkanakul there. Both are UK-trained. http://www.bangkokhospital.com/index.php?p=doctor_profile&DrID=852 http://www.bangkokhospital.com/index.php?p=doctor_profile&DrID=167

Be sure to bring all records especially scan results, and names of all medications he is on.

It is odd that the first scan did not show anything, suggests possibly that what happened was due to vasospasm rather than a clot.

Has he at any point had a doppler ultrasound of his carotid arteries? As this needs to be done. If the doctors don't suggest this (they probably will), specifically ask.

Has be been put on aspirin or other anticoagulent? As that would be important. As would careful control of blood pressure. Get a home BP monitor if you do not already have one.

God luck, and let me know if I can be of further help.

[alyx]

Hello Sheryl

The first scan did not show anything because the stroke was at a very early stage and, therefore, an MRI should have been ordered and an emergency treatment could have helped if not reversed the effects

Instead the "doctor" said that the patient would recover by himself

All exams, in an exhaustive manner, were duly performed: it is an ischemic stroke ( not heart related ) and he is on Folic acid, Plavix and Keppra

I am not arguing that diagnosis

I am just trying to find an explanation for the recurrent motor losses which, from the point of view of the physicians abroad, have to be treated independently from the stroke

Thanks for the suggestion ( I have PM you )

Edited October 5, 2013 by alyx