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Old 11-15-2012, 08:47 PM
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Default Hemorrhagic Stroke

I have a friend who went to the ER Tuesday evening. He was driving and stopped in the middle of the road and told his sister that he was extremely dizzy. No HA. He managed to walk around the van by holding on to it for support.

They dropped a friend off and he started vomiting. The friends and his sister insisted that he go to the ER. He agreed so they took him. Did a blood workup and an MRI/CT scan. It came back negative. Dx: inner ear infection. Meds for dizziness and nausea.

This is where I get confused. I don't know if I misunderstood or if they did. According to his sister he had left sided weakness and numbness. He was also slurring his words. I don't know if he presented that way. I DO know that either his sister told the ER that he was or the sister CALLED the ER after they left.

The ER called her on her cell phone and told her to bring him back there, He REFUSED to go.

I learned about all of this when I went to work this morning. I went down to their house and visited him and talked to his sister. She said that his INR was 1.5 but everything else came back negative.

I don't understand how his INR could be 1.5 when his is on coumidin. He had valve replacement 2 yrs ago and has been faithfully taking his blood thinner and getting tested Q6W.

He was able to move all extremeities, but his speech was still slurred and he was confused.

Anyway, they left about 1430 to go back to the ER. Just before I got off work she called and told us that he had had a MASSIVE hemorrhagic stroke. So bad in fact that they life flighted him to Louisville KY!!

How is it that the ER missed this on Tuesday? How could his INR be so low? What caused it? was it the bleeding? Is it possible that it was a slow bleed and became massive after he got back to the ER today?

Please help me understand. I have searched online for s/s r/t inner ear infection. Yet I also KNEW he was on coumidin. He had ALL the symptoms of a stroke TWO FREAKING days ago!!

Thanks!!
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Old 11-16-2012, 05:24 AM
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Ummmmm Sabby....this isn't the GM thread.....hee hee hee

Karen I'm sorry your friend is having such a rough time....it does sound to me like they may have missed that bleed first time around. Of course, I guess it's possible that he had just the ear infxn the first time, and then ICH the second time.....but that certainly would be a massive coincidence.

As far as his INR, there are several reasons it could have dropped, even if he faithfully took his meds: could be a food or drug interaction, could be a change between different generic manufacturers, could be no good reason. My dad has a devil of a time keeping his INR in check, and we can't really pinpoint why. Switching to branded Coumadin helped things a bit, but he's always going to be self testing qweek. On the other hand, my dose seems to be keeping me therapeutic just fine. I've managed an estimated gazillion people on Coumadin ;) and they seem to have the same experience: some do really fine with their initial dose, while others need constant monitoring/adjustments.

Bleeding will not cause the subtherapeutic INR, but even 1.5 makes him more bleedy than the rest of you guys, so that def didn't make things better....entirely possible he had some sort of congenital malformation that was never detected til now. And yeah, I think it's plausible that he had a slow bleed the first time around that went undetected; remember that the skull is closed, so the blood had nowhere to go and could have caused the sx to progress.

Hopefully your friend does OK, I've seen people bounce back really well after one of these episodes....
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Last edited by dria; 11-16-2012 at 05:42 AM.
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Old 11-16-2012, 06:27 AM
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Totally agree with dria. Will send prayers for your friend. It is possible that he has a small bleed that maybe ruptured a blood vessel a bit more after the ER visit and resulted in the massive bleed.
Most often this is caused by high blood pressure. But can also be caused by an aneurysm, abnormal connections between arteries and veins, cancers, a build up of amyloid protein within the artery walls that makes bleeding more easy ( there is a name for this and I can't recall it ), and of course there is the coumadin thing.
Symptoms can develop suddenly and can come & go depending on where the bleed is.

Keep us posted as you can Karen.


Oh Sabby, I think you may have needed a bit more sleep as this is not the GM thread.
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Old 11-16-2012, 05:20 PM
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Any word on your friend Karen?
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Old 11-18-2012, 09:13 AM
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Please remember that I am getting all this info 3rd and sometimes 4th person.

Supposedly, he did NOT have an ICH instead it was a clot! Now according to what I have heard. He got 2 coumidin on Wednesday night!! According the the ER in Louisville, whatever it was it was massive. He is on medicare, and is Mennonite so MOST Drs think that Mennoites/Amish are ignorant and therefore treat them as such.

According to his sister, his BP was normal [according to the nurse in the ER]. IDK if it actually was normal or if the nurse just wasn't concerned about the numbers. Also according to the ER his INR was 1.5 and was therefore too thick and so he threw a clot. BUT he has no paralysis just numbness. He can walk and move all extremities. He has A-fib and had a valve replacement 2 yrs ago.

He is in ICU and will be re=evaluated Monday. Probably will receive orders to go to rehab/or have it in his home. According to a friend who knows him better that I do, he will NOT do/go rehab.

We will see how things turn out.

Thanks for the kind thoughts and prayers. They are appreciated.

His name is Wilbur and his sister's name is Mary Lou.
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Old 11-18-2012, 09:47 AM
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Quote:
Originally Posted by kwagner_51 View Post

He is on medicare, and is Mennonite so MOST Drs think that Mennoites/Amish are ignorant and therefore treat them as such.

IDK if his BP actually was normal or if the nurse just wasn't concerned about the numbers

The ER called her on her cell phone and told her to bring him back there, He REFUSED to go.

According to a friend who knows him better that I do, he will NOT do/go rehab.
Karen, with all due respect I don't see any healthcare professional treating a patient as ignorant because of their religion.

If because of their religion they are against certain types of medical intervention and refuse things such as returning to the ER when called by the doctor, and by refusing rehab that is not the fault of the doctor but rather the patient. If he has a bad outcome it will be his fault alone. We need to lay blame where it belongs. Sorry just my honest opinion. lots!
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Old 11-18-2012, 12:28 PM
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I was quoting a Mennonite when I said that. I TRUST her opinion of drs. She has had plenty of experience with them. Her experience: MIL dx as needing therapy from same ER REAL DX: CA

Am I saying I believe it? Maybe. I have seen the medical establishment treat them differently. EX: Mom wanted a different kind of sock for her son that are all one piece without the heel pocket. She asked the foot specialist for suggestions. Her answer: "You sew right? Just cut the toe off and sew the sock back together!"

Not exactly respectful and totally ignored the question. Which is why I said MOST!!
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Old 11-18-2012, 12:50 PM
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Will continue saying prayers for them. I know you said clot and another said massive bleed, did he maybe have both? Just curious here. Hope the outcome is a positive one. Keep us posted.
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