Patient: My cousin has experienced a stroke, he is at the hospital now. And while I’m sure they are doing everything to help him I’m concerned.Here’s what I know. He is a 29 year old african american male, apprx 5’9 170 lbs, trim build. He’s been complaining about headaches for 2 weeks, but over the last month has not felt great. he was sent home from the emergency room twice with pain meds, until saturday night when his words started slurring and his family rushed him back to the hospital. Now he has been admitted and they have given him some meds to bring down his blood pressure. but its been swinging drastically, it drops down and shoots up. This is very hard to watch and harder to go through. His symptoms are now very blurred vision, that gets more clear after the doctors drain fluid from his brain, and then his bp starts swinging either to high or too low. he has felt nauseous, and he has had 2 or 3 spinal taps. If you have an idea what might be causing these bp swings, or why a young 29 year old man who has a typical history of good blood pressure 120 / 85, walks and eats healthy, ought of a sudden would have 2 strokes. It would be helpful, I know you can’t diagnose, but if you have some ideas, I will do some research and possibly persuade my aunt to change hospitals. Help…..
Doctor: Hello, Welcome to Ask The Doctor. We are here for your help.From your description, it seems that he has got either Po sterior Circulation Stroke or Middle Cerebral Artery Bleed.Now, you say that they have drained the fluid. This fluid is probably the blood, which means the bleeding was so high in quantity, that it required drainage.You need to understand, that Stroke in a young male with no hypertension requires evaluation for the cause, and the most common cause being Berry Aneurysm or any other aneurysm, that could have ruptured causing this bleeding.The treatment is mostly supportive. Only surgical intervention that is required in such acute stroke is drainage of intracranial blood if the volume is very high causing the compression of the surrounding structures of brain.Blood Pressure fluctuation is common and mostly we don’t treat it even high BP. We try to get the Systolic Blood pressure around 150 mmHg only, as this high BP is reactionary.The mainstay of treatment is conservative management by taking appropriate care of vitals, respiration , nutritional intake.In cases of very high volume of bleed, craniotomy might be required.Such cases are managed with a combined effort of Neurosurgeon, Neurologist and Intensivist.You have to keep patience, as there are no early results seen in such cases and shifting patient to other center can pose a risk.So, discuss with your doctor’s , and if they feel he should be referred to higher centers then only shift him, as i mentioned that treatment is mostly supportive and most of the well equipped centers are capable of providing that level of care.I hope my answer helps you.I wish him a speedy recovery.If you have any further questions, please feel comfortable to ask me, i will try my best to explain you.Take Care.