What causes the motor skills to become abnormal and severe ulcers on both the legs?
Patient: Hi, today I witnessed my elderly father(80 years old) suddenly find it difficult to walk. He could not seem to move his legs . My mother had to help him sit in his wheelchair and put him to bed. His hands were twitching constantly and he was unable to hold anything. He has been unable to chew or swallow his food however he did drink when a cup was held to his lips. My father has experienced bouts of this over the last 3 months,the last one being 9 days ago. My Mother has told me that usually after a few hours my Fathers motor skills and speech become normal. However todays attack was longer than normal. He has suffered with severe ulcers on both his legs over the last 4 years and has been hospitabilised a number of times with bad infections. My Mother has consulted the GP and they have refered my Father to a neurologist however we are still waiting to see the consultant. Can you give us some understanding of what could be wrong with my Father please Doctor: Hi,I am Dr Mittal.I have read your message.I think I can help you.The symptoms of the query are quite suggestive of a stroke. The sudden onset of the symptoms, the motor weakness, the swallowing and speaking difficulty, the shaking of hands. All symptoms are suggestive of the diagnosis of stroke. The fact that he had been having similar episodes over the last 3 months is suggestive of mini strokes that we call TIA medically. These are usually warning signs of an impending stroke.I am unaware from the query about the duration of the symptoms. Within 4 to 8 hours onset should be treated urgently and should be visiting an EMR as soon as possible. He will need urgent treatment.If it is more than that, he needs to meet a neurologist who will probably perform a CAT scan of the brain with or without the angiogram (depending on the protocol of the hospital).As per the report of the CAT scan, medicines may be initiated. I think a low dose statin and antiplatelets should help. I would suggest a scan prior to the initiation of the medicines because the closest differential is a possible cerebral hemorrhage (less likely in view of the mini strokes) where these medicines are not to be given. Meanwhile, i think you should start him on physiotherapy for the motor weakness.Another possibility I want to consider here is possible diabetes and hypoglycemia attacks. If the GP has thought about this as a possibility and tested sugars, there is probably nothing to worry about. Otherwise hypoglycemia in a diabetic patient would explain the brief episodes. And a hypoglycemia can also explain the prolonged symptoms. In such a case, sugars need to be well monitored.The third possibility I need to consider is a vasculitis. This is a common cause of stroke, but usually is thought of in young patients. The last 2 causes I have considered in the view of preexisting foot ulcers which cannot be explained by TIA or current stroke as the ulcers predate the stroke. I think you need to get the scan and meet up with a neurologist. Unfortunately, as explained, I cannot suggest medications without the scan.I have tried to make it as simple as possible. Please feel free to contact me for any further clarification. Best of luck, Dr Mittal