Sequelae of a cerebral haemorrhage with right-sided hemiparesis and motor aphasia – a case study
Prepared by the NORMAN Neurological Rehabilitation Centre.
This case study does not constitute medical advice and does not replace a consultation with a specialist or an individual diagnosis. For questions about your own health, please contact a doctor or physiotherapist.
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Patient details
Sex
Female
Age
75 years old
Main diagnosis
- sequelae of cerebrovascular disease following a cerebral haemorrhage
- right-sided hemiplegia
- right homonymous hemianopia
- central palsy of the right facial nerve
- status post haemorrhagic stroke
Comorbidities
- cerebral haemorrhage into the hemispheres, subcortical
- unruptured fusiform aneurysm at the M1-RMCA bifurcation
- atherosclerosis of the internal carotid arteries
- arterial hypertension with cardiac involvement
- type 2 diabetes
- mixed hyperlipidaemia
- status post vertebroplasty of the T7 vertebral body
Functional status
This case describes the condition following a haemorrhagic stroke with right-sided hemiplegia, motor aphasia and right homonymous hemianopia. The particular nature of the return to function after a cerebral haemorrhage and haemorrhagic stroke is worth noting. Initially the patient was bedridden and required comprehensive nursing care. She moved around in a wheelchair with the assistance of others.
On functional assessment, the most striking findings were movement limitations on the right side, including reduced muscle strength in the right upper limb. Improvement was noted in independently changing position from lying to sitting, in moving independently while seated and standing, and in hand function. The patient walked with the aid of a walking frame. Walking required a frame or the support of another person, indicating a need to work on gait and balance disorders.
In terms of self-care, the patient dressed and undressed independently, carried out hygiene tasks such as brushing her teeth and washing her face independently, and had no problems using a telephone. She was able to prepare a simple meal independently, for example spreading bread or cutting a bread roll. Difficulties concerned simple tidying tasks, dealing with official matters and doing the shopping. In these areas, the assistance of others was indicated as necessary.
In terms of communication, there were initially pronounced difficulties with both understanding and producing speech. Verbal communication took the form of "word salad", and the patient was unable to state basic family and address details correctly. Improvement was subsequently noted. The patient was willing to engage and communicated coherently, could read basic messages and instructions, and mathematical functions were preserved. Verbal fluency remained impaired.
Significant medical events
The clinical course involved the sequelae of a cerebral haemorrhage, with right-sided hemiparesis, motor aphasia, right homonymous hemianopia and central palsy of the right facial nerve.
ECG studies showed sinus rhythm, isolated atrial ectopic beats, sinus arrhythmia and features of sinoatrial conduction disturbance. The glycaemic profile showed intermittently elevated blood glucose values. An application was submitted for a walking frame and for incontinence pads.
On psychological assessment, initial findings included reduced activity, disorientation and difficulty in fully assessing cognitive function on account of the aphasia, hemianopia and paresis. Subsequently, full personal and situational orientation, coherent verbal contact, preserved selectivity and concentration of attention, increased mental fatigability, impaired planning and abstract thinking, and impaired visuospatial function were described. No expressions of resignation, hallucinations or delusions were noted.
Patient status on completion of hospital treatment
On completion of hospital treatment, the patient was in good general condition. She required minor assistance with activities of daily living and supervision of her medication. She walked with the aid of a walking frame or with the support of another person.
Improvement was noted in overall physical fitness, in the muscle strength of the right limbs, and in the endurance and confidence of her walking. A marked improvement in speech was also noted. Verbal contact was coherent, and the patient was able to communicate with those around her about everyday activities, needs and emotions.
Continued care by a general practitioner was recommended, along with a diabetic diet, blood glucose monitoring, periodic monitoring of full blood count, creatinine and electrolytes, and regular monitoring of blood pressure. Periodic specialist reviews were also indicated, as well as the need for support from others, daily monitoring of well-being and supervision of medication.
Next stage of rehabilitation
On completion of hospital treatment, further comprehensive outpatient rehabilitation was recommended, along with continuing at home the exercises learned during the hospital stay. Further speech and language therapy focused on speech rehabilitation was also recommended, for example in the form of a speech therapy stay after stroke, together with cognitive training at home, whose importance after stroke is significant for recovery.
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