Dr. Dean Johnston, Neurologist, Vancouver, BC

Recent Health Talks Authored by Dr. Dean Johnston

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  9

  Managing Stroke in an Elderly Patient " >Bob a 77-years-old experienced clumsiness of his right hand "

  Bob is 77-years-old and experienced a brief episode of clumsiness of his right hand last weekend. The spell lasted about 20 minutes and he found his hand was heavy and he could not turn the key in the lock of his door. He did not note numbness or speech problems.

  About 4 weeks ago, he had a spell of painless loss of vision in his left eye. It lasted 5 minutes and has not recurred.

  Last year, Bob suffered a heart attack and this caused him to finally quit smoking. He has had high blood pressure for 10 years and recently found out his cholesterol was high as well. He is relatively sedentary and does not like to exercise for fun. He does a little gardening.

  Bob has suffered two TIA's in the last month. He is at high risk for stroke and must be assessed immediately by a doctor experienced in stroke prevention. He must undergo a CT head scan and CTA or ultrasound of his carotid arteries as soon as possible. He should also undergo blood tests and a heart rhythm test known as a 24-hour holter monitor. Once he has consulted his doctor, he should start taking aspirin daily and have his blood pressure and elevated cholesterol strictly controlled. He must exercise at least 3 hours per week (this can simply be brisk walking).

  Bob should be seen by a neurologist for examination and further education on stroke symptoms. He could also benefit from seeing a dietitian to learn more about making changes to help reduce his cholesterol levels and perhaps even help control his blood pressure. He needs to see a radiologist for a CT head scan. A diagnostic imaging lab may also do a CTA or ultrasound on his carotid arteries. A pharmacist may be able to help Bob manage all of his medications properly and set him up at home with a blood pressure monitor. An athletic therapist could help Bob introduce manageable exercises at home that he can incorporate along with his walking.

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  Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

  Bradley is a 20-year-old hockey player who collided with the boards after a hard body check. He was not knocked unconscious, but felt dizzy and nauseated. He could not remember the score in the game or the name of his coaches. A trainer at the rink assessed him for concussion and did not let him return to play.

  Later, he developed a headache and couldn’t sleep that night. The next day he noted that his balance was off, he couldn’t tolerate any noise or bright lights, and he felt nauseated when looking at the TV or computer. He couldn’t organize his thoughts and he felt as though he was in a fog. He became irritable and occasionally tearful. He could not return to school.

  Bradley should first be assessed by his family physician or a sports medicine specialist within 24-48 hours. He should not return to play for a minimum of four weeks, and not before his symptoms have resolved. A determination about whether a neurologist should be consulted and whether an MRI is needed can be made. Medications may be helpful to treat some of the symptoms. A psychologist may be consulted for management of mood symptoms and assessment of psychological function.

  As his symptoms settle, Bradley may benefit from a graduated conditioning program under the supervision of a physiotherapist or athletic trainer. A plan for returning to play can be made with the help of his physicians. Persistent symptoms (post-concussion syndrome) may develop and he should be monitored by his physician until his symptoms resolve.