medical advice

Sankar Lal Chakrabarty,(about 70 years) is a known case of Diabetes, Hypertension & Dyslipidaemia. Mr. Chakrabarty has been suffering from Action tremor for last few years and he suddenly developed some intellectual and memory problems at the end of 2002.The above are unlikely to be due to the ventricular dilatation seen in the MRI of 2004.The findings from the MRI done on 12.07.05 are
As follows:
On T2W and FLAIR images hyperintense foci are noted in both centrum semiovale and both corona radiata. CSF signal intensity fociwith surrounding hyperintensity are noted on FLAIR images in left corona radiata and genu of the left internal capsule, suggesting old cavitated infarcts. Periventricular and suraventricular hyperintensities are noted on T2W and FLAIR images. Mild cerebral cortical atrophy is noted as evidenced by slightly enlarged cortical sulci and increased CSF spaces over both cerebral hemispheres. Both lateral and 3rd ventricles are grossly dilated. Midline structures are not shifted. The rest of the image findings are unremarkable. Retention cyst is noted in the left maxilary sinus, suggesting sinusitis. Focal T1 intermediate and T2 hyperintensity area is noted in the left mastoid region, suggesting mastoiditis.

Impression:
Lacunar infarcts of different ages in the above mentioned locations with mild cerebral atrophy having central predominance. Chronic ischemic charges in the periventricular white matter. He was evaluated at the Appolo Hospital , Dhaka, Bangladesh HTN, DM-on Immulis, Multi-intarct and degenerative dementia, tremor predominant parkinson and OCE.DYSPEPSLA. He was prescribed drugs like Perkinil, Donepezil Hydrochioride, Vitamins. Hypen-sr. Before taking this medicine he had only hand tremor and intellectual problem to a certain extent (difficulty in mental arithmetic, problem in identifying directions etc.). But his condition started deteriorating after this treatment during the last two months. He has now difficulties identifying persons, places, speech problem , difficulty in walking , difficulty in bathing, difficulty in swallow, always chewing, difficulty in taking food, urine problem at the night in the bed , balance problem etc. He is now on drugs like Lucetam (piracetam) 2400 mg a day, duxil (almitrine + raubasine) , Diltiazem HCI USP 90 mg, indapamide 15mg, Trihexyphenidyl Hydrochloride 2 mg, Larcanidipine Hydrochloride 10mg, Multi vitamin-multi mineral, Enalapril maleate USP 20 mg,
Inj. Actrapid, insulatard. His diabetics and hypertension are under control. Exelon stopped few days back. Urine and stool out of control. temparature is there.His condition is deteriorating day by day. We seek medical advice.