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Question
Posted by: worried | 2003/02/18

seizures and blood clots

Dear Doc

I hope you can help. My mom suffered from cervical cancer in 1994, 2000 and 2001. She has received treatment for it namely hysterectomy, radium implant (1994), and chemo (mainly platinum - 2000), radiation therapy in 2001 and more chemo (gemsar - I think) in 2001/2002. She has been in "remission" since April last year. Her medical problems are numerous. Firstly she has extreme back pain and is permantly on durogesic pain patches and tramil slow release. She has consulted her oncologist, neurosurgeon (gave cortisone injections -3), orthapaedic surgeon, physiotherapist and even acupuncture for her back - to no avail. The MRI revealed minimal arthritis - not enough to cause the severe back pain. At night she has to sleep up right, can't lay down flat. The doctors concluded it was psychsomatic, but that is not possible as she is a highly intelligent woman with degrees and books (academic) behind her. Blood tests (July 2002) revealed the createnine in her blood to be high and the psychician treated her for kidney infection with anti-biotics!! Her oncologist told her to go home and rest!!!

Last November her left leg swelled up considerably and after much investigation, (the specialists were unconcerned and referred her to the GP!!) it was discovered by our own trial and error and by talking to people on the periphery of medical science (radiologists, chemo nurses), through desperation after being refused attention by doctors, that she has lymphoedema (blockage of the lymph nodes with a stagnation of the lymph and no flowing in the leg). We managed to find a physio doing lympahtic drainage and the GP ordered a support stocking for her. Everything was ok except the physio did not releave the leg, in fact it swelled even more while she was on treatment. At this time (Nov 2002) she had a ultrasound to eliminate the possiblity of clots in her blood. Last Tuesday, she had a seizure and was rushed to casulty. Just after the seizure, she was not concious, muttered unintelligible words and started to talk, but did not make sense. When she came round, she still gabbled on, but when she reached the hospital she was fine (filled the admission forms in, knew her name, ID Number etc and wrote with a steady hand). She had a CT (brain) scan with contrasting dye. They saw that her brain had a lesion on it. Gave her some anti-epileptic medicine and sent her home. She was due to see the physician tomorrow. The medication made her severley ill, vomiting and nauseous to the extent that she was twice at casulty on the weekend receiving injections for nauseous and pain. Last night she was admittied into hospital with clots in her left leg (the leg in which she has had the severe lymph swelling since Nov last year).

Sorry for this lengthy e-mail. But my questions are thus: What is a lesion? Secondly, is it possible that her seizure could have been caused by a small clot passing through her brain and it had gone through by the time of the CT scan which did not pick it up? The physician kept on saying that the scan was unclear (in other words they were not sure of the cause of her seizure). Will the medication they have her on now thin her blood and dissolve her clots? Is she in severe danger now of a clot passing through her heart or brain even though they have ordered bed rest in the hospital? Which doctor should she consult? Her oncologist? The physician they called in last week after her seizure or a surgeon which they seem to have her now with while she is in hospital? This whole thing is confusing, the doctors have not been helpful and they keep on passing the buck. They only treat her for one thing, and are not prepared to look at anything else. No-one is really prepared to help my mother who is suffering with life-threatening conditions

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Our expert says:
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Worried, a lesion means there in an abnormality on the scan. It just says that there is something, but not what this something is.
It’s possible that the seizure was due to a clot like you said, but it’s also possible that it’s due to the lesion or that the lesion is the bleeding associated with the seizure/stroke.
I’m not sure what medication she’s on, but thinning her blood might be dangerous if they don’t know what the lesion is.
A blood clot should go straight through her heart and not cause problems there. Where it goes from there will determine how bad the damage is.
I suppose the best person to see would be her oncologist as he will be able to give you the most information on her condition.
It might be that the doctors don’t want to give you bad news when they’re not 100% sure of what’s going on. It might be that the cancer has returned and that the lesion is a metastasis, but at this stage they’re not sure yet. I hope that I’m wrong, so please let me know when you have time. Good luck.

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