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My mom, 90, had a stroke July 1. I spent most of July, Aug and some of Sept with her during rehab. Even with rehab, continued to decline. Became paranoid, suspicious at second rehab facility; dxed with vascular dementia. Moved her to AL, she passed out there; in hosp with extremely high bp for 5 days, back to AL in demntia unit with 24/7 aide. Fell, broke her hip, surgery. Now again in rehab. We think, because she's now in a Catholic place with lots of priests, nuns, stained glass, much calmer, seems to be progressing. Walking with walker. No longer thinking that she owes money; no longer saying that she's a bad person, not worthy of prayer. Is this dementia? How do we tell? I really, REALLY don't want to put her through another MRI, she wept through the last one. Her last CAT can, two weeks ago, when she broke her hip, looks like her brain is swiss cheese, to quote the doc who read it. She is now having sudden onset headaches, across her forehead every afternoon. Take her to a neurologist? To what end? Just feeling at sea here; my brother, who is POA is ten minutes away, but we are all HCPs and I am a psychologist with a limited amount of clinical knowledge.

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I am interested in the sudden headaches occurring every afternoon. does she get them at the same time Is she placed in a similar location to sit. Does the sun come round and shine in her eyes.. Is there some kind of repetitive movement - maybe a suncatcher spinning. Is she put in a position that she can't move from where her head is at an angle that restricts the blood flow to her head? It is always necessary to look for simple solutions before firing off the big guns. I can not tell you whether it is wise to put your mother through a more extensive evaluation in the light of the previous comment on the swiss chees appearance of her brain. Causing the least possible distress would be my first thought but whatever you decide - not what the doctors recommend should be done out of love not guilt. She is in a very peaceful place and responding to the tranquil atmosphere. A diagnosis is always nice to have but what are you going to do with it and how will it improve your mother's wellbeing. Talk to the nuns and the Mother Superior to help you find your peace
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I had another thought too, and that would be what are they doing to try to prevent or delay any further strokes? If they aren't doing anything or haven't checked to make sure she is responding to anti-platelet therapy, either an internist or neurologist might be of help with that too.
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I can't imagine her vascular dementia went away, but it is great she is feeling better in a nicer, more familiar and comforting place. Maybe they also treated some infection and/or changed some meds to things she tolerates better too.

Sometimes an internist or geriatric specialist can properly evaluate and treat headaches, you might want to give the facility physicians the information about them, whether she has had them before, history or family history of migraine, etc. and see what they think. Another imaging might or might not be of any help in management of those and making her feel better, which I think might be the most important goal.
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A diagnoses all depends on how important it is for you to know for sure if she has dementia. A stroke can cause a lot of damage to the brain depending on how severe it was. A neurologist can help, and you should be able to get the MRI to a neurologist since it was recent. Saying her brain looks like swiss cheese is a bit of a cold diagnoses. I am so sorry you are going through this. Getting her seen by a neurologist for the headaches and a diagnoses from him/her would be the best thing to do. My husband suffered a mild stroke a month ago and was told to follow up with a neurologist. He had speech therapy for about 3 weeks and they released him from any further therapy. The appointment with the neurologist is not until December...the soonest we could get in. So yes, follow up with a neurologist!!
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