Wockhardt Hospitals Nagpur is a leading healthcare provider with a tradition of care and innovation that makes this hospital a boon for patients in Central India. Wockhardt Hospitals Nagpur, which handles critical patients, successfully operated on yet another critically ill patient while avoiding major surgery .
Mrs (ex) 70 years old female presented with 3 months history of progressive worsening of right arm functions with inability to do day to day activities like dressing herself, eating.
She had switched to the left hand for most of her activities. For 1 month, she had new onset difficulty in speaking with difficulty finding right words with involuntary drifting of right arm backwards and up while walking. She had a history of falls while cleaning her house from a flight of stairs without any obvious external injury or loss of consciousness.
On examination she had right sided alien limb phenomenon with inability to perform simple motor activities ideomotor apraxia (an impairment in the timing, sequencing, and spatial organization of gestural movements) with nominal aphasia (loss of language capability caused by brain damage) suggestive of a cortico-basal syndrome (is a condition that causes changes in movement, language skills or both) Dr. Amit Bhatti suggested for MRI and the MRI brain showed a large left fronto-temporo-parietal acute on chronic Subdural hemorrhage (in lay man’s term- it is a bleeding between the brain and the skull). She underwent an awake burr hole evacuation of the hematoma, a procedure to remove the bleeding. Her deficits totally recovered within 48 hours of surgery and she was discharged.
15 days later she started complaining of headache with nausea and a CT brain done again showed recollection of subdural hematoma. The option was complete membranectomy under general anesthesia. Chronic subdural hematoma (cSDH) is a common pathology that typically affects the elderly. As the patient was old and had multiple comorbidities, Dr. Amit Bhatti had the option of middle meningeal artery (MMA) embolization and it was given. MMA embolization was done under local anesthesia and patients’ headaches subsided after 24 hours.It was a unique case without a major surgery.
Middle Meningeal Artery embolization (MMA) is a procedure done through the small artery of the hand or leg without going for major surgery. Major surgery involves the opening of the brain which can be risky in elderly frail patients and has a lot of morbidity . Dr. Amit Bhatti with his expertise saved the patient from undergoing the major surgery and that too with just 24 hours of hospital stay and 1\3rd of the cost of open surgery
Dr. Amit Bhatti is M.D. D.M. (Neuro) D.N.B (Neuro) FINS (Interventional Neurology & Stroke) Consultant – Interventional Neurologist.
Over the next 3 months the patient was followed up regularly and did not show any new neurological signs or symptoms. Her CT brain after 3 months showed near complete resolution of the SDH with no membrane. Thus, MMA embolization using endovascular route which means a treatment is performed inside your body using long, thin tubes called catheters. The catheters are inserted in small incisions in the groin or arms, and are guided through the blood vessels. And this treatment may be an option for elderly patients and in patients on antithrombotic therapy and those with major cardiac or systemic diseases ( eg. high blood pressure, influenza ) who may otherwise be very high risk candidates for open craniotomy (surgical removal of a portion of the skull) and general anesthesia.
Mr. Abhinandan Dastenvar, Centre Head Wockhardt Hospitals Nagpur said , ” We are very proud that Wockhardt Hospitals Nagpur have such expert and specialist team of doctors. We are always there to help the common man and do it deligently. “