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Suggest Treatment For Hemiparesis In An Elderly Person
Question: Brief - My mother's left part is paralyzed after her right carotid artery is blocked 100%. Not a 10% recovery seen through 2 years physiotherapy by certified doctors.
Detail -
She (64 Years, Weight 69 KG) had first stroke in Oct 2013, her left carotid had 80% blockage and right had 50%. We did endarterectomy of left artery in May 2014. Within next 48 hours of surgery she got another stroke and her right carotid artery got 100% blocked.
Doctors suggested recovery through physiotherapy. Now its almost 2 years, we tried best physiotherapist, even twice a day but we haven't seen even a 10% progress which suggests there could be some other problem and giving thought to find something else.
She is very much conscious, she has good memory of her past, she eats properly, sits and do whatever she can do with her right part. Only drawback she gets emotional frequently as she was very active in her good days.
I am writing for your help & valuable suggestion - can you please suggest what's the issue? why is she not recovering through physiotherapy? and lastly what's other option now? could you please suggest what should we do now?
Detail -
She (64 Years, Weight 69 KG) had first stroke in Oct 2013, her left carotid had 80% blockage and right had 50%. We did endarterectomy of left artery in May 2014. Within next 48 hours of surgery she got another stroke and her right carotid artery got 100% blocked.
Doctors suggested recovery through physiotherapy. Now its almost 2 years, we tried best physiotherapist, even twice a day but we haven't seen even a 10% progress which suggests there could be some other problem and giving thought to find something else.
She is very much conscious, she has good memory of her past, she eats properly, sits and do whatever she can do with her right part. Only drawback she gets emotional frequently as she was very active in her good days.
I am writing for your help & valuable suggestion - can you please suggest what's the issue? why is she not recovering through physiotherapy? and lastly what's other option now? could you please suggest what should we do now?
Brief Answer:
Continue treatment and provide more details, reports
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
The recovery in stroke depends upon area involved.
As in your mother, carotid artery block was present which means involvement of most part of right hemisphere. Frontal lobe involvement leads to emotional and behavioural problems.
As left side of brain is not involved, speech is preserved in right handed person.
Physiotherapy helps in maintaining tone and prevents contracture at joints but power recovery occurs by brain tissue changes.
As 2 years have passed and only 10 % improvement is there so much improvement is not expected in future.
You should visit a neurologist regularly. Power is assessed by a doctor and your 10 % assessment may not be actual improvement.
Is there any movement in involved side?
Is she able to move limbs in bed?
Is she able to stand or walk?
Sometimes increased tone hampers movement of limbs and botox injection will be of great help in such a case.
Hope you found the answer helpful.
Do get back to me for further queries.
Upload any reports if available
Regards
Dr N Kumar
Neurologist
Continue treatment and provide more details, reports
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
The recovery in stroke depends upon area involved.
As in your mother, carotid artery block was present which means involvement of most part of right hemisphere. Frontal lobe involvement leads to emotional and behavioural problems.
As left side of brain is not involved, speech is preserved in right handed person.
Physiotherapy helps in maintaining tone and prevents contracture at joints but power recovery occurs by brain tissue changes.
As 2 years have passed and only 10 % improvement is there so much improvement is not expected in future.
You should visit a neurologist regularly. Power is assessed by a doctor and your 10 % assessment may not be actual improvement.
Is there any movement in involved side?
Is she able to move limbs in bed?
Is she able to stand or walk?
Sometimes increased tone hampers movement of limbs and botox injection will be of great help in such a case.
Hope you found the answer helpful.
Do get back to me for further queries.
Upload any reports if available
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Thank you Dr. XXXXXXX
I am attaching Angiography & Color Dopler reports for your reference.
As I said we didnt see even a 10% improvement while we personally saw almost 80-90% recovery in many cases. We were expecting at least 50% recovery as 2 years is a long duration, still she can't seat without support.
Here's answer to your queries -
Is there any movement in involved side?
- Yes, she respond a little during physiotherapy session.
Is she able to move limbs in bed?
- Yes she does but mostly with support of her active part i.e. right leg & hand
Is she able to stand or walk?
- Nope, she stands and walk with outer support and take complete load on her right part, no movement or support through affected part.
She's sensation in her affected side, like she complain pain in left leg, when we pinch she feels it etc.
Please note that - This is almost same condition when she got paralyzed 2 years back. Infact we are seeing stiffness in left part.
Why I am looking for something else because I personally feel if there was any recovery through physiotherapy then we would have seen at least 30-50% improvement. At least she should be able to do her personal tasks at her own. Right now she needs assistance for every single task.
Please suggest what best we can do here, any advance physiotherapy solution available? or do you think botox can help? or any other valuable solution you can suggest?
Requesting you to please treat this case as a rare case and please suggest whatever best you can.
Regards XXXXXXX XXXXXXX
0000
I am attaching Angiography & Color Dopler reports for your reference.
As I said we didnt see even a 10% improvement while we personally saw almost 80-90% recovery in many cases. We were expecting at least 50% recovery as 2 years is a long duration, still she can't seat without support.
Here's answer to your queries -
Is there any movement in involved side?
- Yes, she respond a little during physiotherapy session.
Is she able to move limbs in bed?
- Yes she does but mostly with support of her active part i.e. right leg & hand
Is she able to stand or walk?
- Nope, she stands and walk with outer support and take complete load on her right part, no movement or support through affected part.
She's sensation in her affected side, like she complain pain in left leg, when we pinch she feels it etc.
Please note that - This is almost same condition when she got paralyzed 2 years back. Infact we are seeing stiffness in left part.
Why I am looking for something else because I personally feel if there was any recovery through physiotherapy then we would have seen at least 30-50% improvement. At least she should be able to do her personal tasks at her own. Right now she needs assistance for every single task.
Please suggest what best we can do here, any advance physiotherapy solution available? or do you think botox can help? or any other valuable solution you can suggest?
Requesting you to please treat this case as a rare case and please suggest whatever best you can.
Regards XXXXXXX XXXXXXX
0000
Brief Answer:
Optimize drugs for spasticity to have best possible effect
Detailed Answer:
Hello Mr XXXXXXX
I have gone through all previous reports and discharge and the current prescription.
The medications are ok.
There is spasticity in involved side and liofen Xr is being given for the same.
Other options are gradually increasing the dose of liofen to decrease the spasticity or add tolperisone for spasticity with lesser sedation.
Botox is another option if spasticity is more and less responsive to medications.
Sometimes, spasticity may mask the improvement in power recovery.
You can visit to a neurology centre or another neurologist for second opinion.
Physiotherapy should be continued.
Regards
Dr N Kumar
Neurologist
Optimize drugs for spasticity to have best possible effect
Detailed Answer:
Hello Mr XXXXXXX
I have gone through all previous reports and discharge and the current prescription.
The medications are ok.
There is spasticity in involved side and liofen Xr is being given for the same.
Other options are gradually increasing the dose of liofen to decrease the spasticity or add tolperisone for spasticity with lesser sedation.
Botox is another option if spasticity is more and less responsive to medications.
Sometimes, spasticity may mask the improvement in power recovery.
You can visit to a neurology centre or another neurologist for second opinion.
Physiotherapy should be continued.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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