TY  - CHAP
M1  - Book, Section
TI  - Vascular Supply of the Central Nervous System
A1  - Mosconi, Tony
A1  - Graham, Victoria
PY  - 2017
T2  - Neuroscience for Rehabilitation
AB  - >  CASE  2Atrioventricular  MalformationDavid  K  was  driving  through  a  busy  southern  California  intersection  when  his  left  arm  and  leg  stopped  working.  He  glided  to  the  side  of  the  road,  partially  blocking  traffic.  Realizing  something  was  wrong,  he  called  911  and  reported,  “I’m  at  Plummer  and  Reseda,”  but  the  operator  kept  asking  him  to  repeat  himself.  His  memories  of  the  event  fade  in  and  out;  he  unlocked  his  car  and  put  a  note  on  his  windshield  to  call  for  help.  When  the  paramedics  arrived,  they  found  him  slumped  over  the  steering  wheel  and  asked  his  name,  but  he  was  only  able  to  point  to  his  wallet  in  response  to  their  questions.  His  speech  returned  during  the  ambulance  ride;  he  spent  the  entire  time  trying  to  convince  them  to  stop  for  hamburgers.  Once  at  the  local  hospital,  he  was  transported  to  CT  scan  to  determine  the  cause  of  his  acute  neurologic  decline.  Clinical  findings  were  consistent  with  a  cerebral  vascular  accident.  Test  results  were  positive  for  ischemic  rather  than  hemorrhagic  onset,  qualifying  him  for  the  drug  t-PA  (tissue  plasmin  activator).David  K  was  an  active  man  in  his  early  50s,  working  as  a  software  engineer.  His  true  passion,  however,  was  his  volunteer  work.  Thirty  years  of  running  around  soccer  fields  as  a  referee  gave  him  strong  legs  and  excellent  cardiovascular  fitness.  This  high  level  of  fitness  may  be  the  reason  his  physician  neglected  to  follow  up  with  a  cardiology  consultation  when  he  found  an  abnormal  heart  rate  (arrhythmia)  during  a  routine  check-up  six  months  prior.  Atrial  fibrillation  causes  inefficient  blood  circulation,  subsequent  pooling,  and  increased  risk  of  clot  development.  Released  clots  impede  circulation  and  cause  tissue  damage  through  ischemia.  David  had  several  large  clots  (thrombi),  which  settled  in  his  right  middle  and  posterior  cerebral  arteries.  The  t-PA  is  most  effective  when  delivered  during  the  first  few  hours  after  ischemic  stroke,  and  probably  saved  David's  life.  However,  the  neurologic  damage  was  severe,  and  he  remained  unable  to  control  motion  of  his  left  side.  Four  days  later,  David  developed  a  thrombus  in  his  right  calf,  underwent  vascular  surgery,  and  was  placed  on  temporary  bed  rest.A  dislodged  thrombus  (thromboembolism)  can  travel  up  to  the  heart  or  brain  and  cause  serious  damage,  including  death.  This  prolonged  period  of  inactivity  cost  him  dearly,  as  he  developed  severe  tightness  in  his  knee,  which  delayed  his  recovery  and  ability  to  participate  in  therapy.  David  remembers  fighting  for  every  week  of  rehabilitation,  constantly  being  told  that  there  was  little  chance  of  improving.  His  course  of  care  was  typical,  even  better  than  the  average,  as  he  had  insurance  and  spent  six  weeks  in  an  acute  care  hospital  with  several  weeks  in  a  CARF  (Commission  on  Accreditation  of  Rehabilitation  Facilities)–accredited  interprofessional  inpatient  rehabilitation  unit.  This  unit  provided  hours  of  daily  intensive  rehabilitation  therapy,  with  coordination  by  a  physiatrist  (physician  specializing  in  physical  medicine  and  rehabilitation).  The  program  included  occupational,  physical,  speech,  and  recreation  therapy;  neuropsychiatric  evaluation;  social  work;  and  consistent  nursing  services  emphasizing  family  training,  emotional  coping,  and  self-care.  He  was  discharged  to  home  health  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/20
UR  - accessphysiotherapy.mhmedical.com/content.aspx?aid=1148429528
ER  -