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CASE 7: CEREBELLAR STROKE

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> CASE 7 Cerebellar Stroke

Mali wriggled in her mother's arms, smiling and playing with her rattle as they sat on the couch in the small, furnished apartment the family was staying in during the remodel. Tabitha spoke of the harrowing events of the past year, her voice occasionally soft with emotion. Originally from the same small town, Tabitha and her husband reconnected after college and married soon after. Five months into marriage, they found she was pregnant with a baby girl. Tabitha was 33 weeks along at the baby shower. With another seven weeks left until full term, her husband was increasingly concerned about the health of his vivacious wife.

The first trimester had passed without complications. The onset of extreme fatigue early in her second trimester was unusual, but not a specific concern. As Tabitha entered the third trimester, she developed horrible headaches, so bad they disturbed her sleep. She was diagnosed with sinus headaches and initially responded to ephedrine with some reduction in pain, although a later episode brought her to the emergency room, and she was referred to an ear, nose, and throat specialist. The visit was on a rainy day, and she got confused and lost driving to the appointment. Her symptoms were too subtle for definitive diagnosis, and everyone attributed her confusion to “pregnancy brain.” She tried using a neti pot (nasal irrigation with a saline mixture), with minimal benefit, again visiting the doctor when the headaches became worse, experienced as loud booming in the back of her head. She lay in a dark room in the physician's office, diagnosed with a migraine and given drops for a sinus infection, which helped for a bit. Another emergency room visit was occasioned when Tabitha became concerned that she had developed preeclampsia. Eclampsia is a dangerous condition that can cause seizures and lead to coma during a pregnancy; increased blood pressure, swelling of the extremities, and albuminuria characterize preeclampsia. Tabitha drove herself to the drug store to take her blood pressure, and on the way home collapsed before the front door of her neighbor, who called Tabitha's husband.

Unfortunately for Tabitha, normal pregnancy brings many new and vague symptoms precipitated by dramatic hormonal changes, and her many symptoms were dismissed as the experiences of a young, dramatic first-time mother. So instead of continuing to reach out to the medical professionals in her life, who had been unable to explain her ongoing symptoms, Tabitha dismissed her loss of taste and sensation on one side of her tongue, increasing clumsy behavior, right leg weakness, and loss of balance to pregnancy side effects.

Tabitha could barely walk at the baby shower due to increasing right leg weakness. The next morning, Tabitha was so sleepy, her concerned husband asked her mother to come over before he left for work. Her mom helped her into the shower and got her to eat a little something. She threw up and had a ...

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