Ischaemic stroke of the left cerebral hemisphere with right-sided hemiparesis and 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
Male
Age
70 years old
Main diagnosis
- ischaemic stroke of the left cerebral hemisphere with minor haemorrhagic transformation
- right-sided hemiparesis
- sensorimotor aphasia with features of dysarthria
- right homonymous hemianopia
- status post surgical treatment of stenosis of the left internal carotid artery
Comorbidities
- arterial hypertension
- type 2 diabetes
- hyperlipidaemia
- status post two episodes of TIA with visual disturbances
- status post surgical treatment of critical stenosis of the right internal carotid artery
- right-sided hemihypaesthesia
Functional status
This case describes a patient following an ischaemic stroke of the left cerebral hemisphere. The patient was conscious, but verbal contact was considerably limited on account of sensorimotor aphasia. He understood simple commands and attempted to repeat after the examiner, whereas comprehension of long and complex commands was impaired.
On functional assessment, the most striking finding was right-sided hemiparesis. The right upper limb was paralysed, which required targeted hand rehabilitation after stroke, and in the right lower limb a considerable reduction in muscle strength was noted. Reduced muscle tone in the right limbs, brisk reflexes on the right side and a pathological sign on the right side were described.
Right-sided hemihypaesthesia and right homonymous hemianopia were also noted. On examination, a full range of eye movements was described, along with the ability to indicate by gesture the number of fingers shown in both visual fields.
In terms of communication, disturbances of naming, repetition and speech motor function were described, qualifying the patient for speech rehabilitation. Automatisms were available. Features of dysarthria were present. The patient required comprehensive care and nursing. The trunk was assessed as stable, and verticalisation attempts were carried out.
Significant medical events
In this case, stenosis of the left internal carotid artery was noted and treated surgically. After the procedure, stroke symptoms appeared in the form of right-sided hemiparesis and aphasia. Revision of the left internal carotid artery was performed, with resuturing of the intimal step and arterial patch angioplasty.
MRI of the head revealed foci of acute or subacute ischaemic stroke, including an extensive focus in the left cerebral hemisphere with features of haemorrhagic transformation and several small ischaemic foci on the right side. A follow-up CT of the head described an area of ischaemic stroke in the left frontotemporoparietal region with features of minor haemorrhagic transformation.
Neurological, speech and language therapy, internal medicine, rehabilitation and psychiatric consultations were recorded. During hospitalisation, an episode of getting out of bed and falling was described, after which the patient required psychiatric assessment.
Patient status on completion of hospital treatment
On completion of hospital treatment, significant neurological sequelae persisted. The modified Rankin score was assessed at 4, and the NIHSS at 15. Right-sided hemiparesis, right-sided hemihypaesthesia, right homonymous hemianopia and sensorimotor aphasia with features of dysarthria were still present.
Partial preservation of comprehension of simple commands was noted, with persistent significant difficulties in verbal communication. The patient required further care, nursing and continuation of neurological rehabilitation, including work on hand and upper limb paresis.
Next stage of rehabilitation
On completion of hospital treatment, the patient was qualified for neurological rehabilitation.
Rehabilitation programmes matched to this case
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Neurological rehabilitation staySymptoms and deficits described in this case
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