RT Book, Section
A1 Mosconi, Tony
A1 Graham, Victoria
A1 Neiberg, Maryke
A2 Mosconi, Tony
A2 Graham, Victoria
SR Print(0)
ID 1148430820
T1 Cerebral Cortex
T2 Neuroscience for Rehabilitation
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071828888
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1148430820
RD 2024/04/16
AB >  CASE  10Hemorrhagic  StrokeDr.  T.  stood  in  the  den,  pointing  with  his  cane  to  the  tin  soldier  collection.  Walking  was  slow  since  the  hemorrhagic  stroke,  due  to  the  residual  weakness  in  his  trunk  and  right  side.  His  voice  soft  and  his  right  hand  stiff  and  shaky  from  nearly  two  hours  of  speaking,  he  carefully  pointed  out  the  impressive  collection  of  tiny  figurines,  displayed  in  cases  of  his  own  design  and  construction.The  doctor  and  his  wife  of  54  years  were  just  getting  ready  for  bed  that  night,  nearly  two  years  ago,  when  he  collapsed,  unresponsive.  Paramedics  took  them  to  UCLA  Medical  Center,  where  Dr.  T.  remained  active  as  a  director,  researcher,  and  educator.  During  the  first  few  hours,  as  his  wife  and  their  children  waited,  he  underwent  first  a  CT  to  rule  out  trauma  or  a  tumor,  and  then  an  MRI  to  establish  the  amount  of  tissue  damage.  The  team  consulted  and  decided  an  emergency  craniotomy  was  indicated,  to  reduce  cerebral  damage  from  the  edema.  In  the  days  that  followed,  he  began  to  move  his  left  side,  and  he  was  able  to  take  his  wife's  hand,  but  his  right  arm  and  leg  remained  weak,  and  his  speech  was  limited.  He  could  speak  haltingly,  using  only  a  couple  words  at  a  time  for  most  communication  except  for  one  topic.When  his  health  care  team  came  to  discuss  his  plan  of  care,  he  resorted  to  old,  deeply  ingrained  communication  skills  honed  over  decades  as  a  physician  and  fellow  team  member.  He  remained  fluent  in  medical  jargon  and  was  able  to  discuss  and  participate  in  medical  decisions.  Over  the  years,  he  had  treated  thousands  of  patients,  and  nearly  150  new  patients  each  month,  in  his  role  overseeing  coronary  care.  This  exposure  proved  valuable  during  his  post-stroke  recovery.  “Phlegmasia  cerulea  dolens,”  he  stated,  slowly  for  emphasis.  He  had  recalled  the  words  and  was  able  to  say  them  clearly  and  distinctly  to  his  physicians.  It  was  a  rare  and  potentially  fatal  condition  he  had  seen  in  patients  who  reported  horrific  pain.  “My  cardiologist  immediately  took  action  and  started  treatment,”  he  recalls.  “I  recognized  the  symptoms  in  myself,  particularly  the  pain,  worse  than  any  I’d  ever  experienced,  worse  than  any  fractures,  or  even  passing  a  kidney  stone.”Phlegmasia  cerulean  dolens  is  a  rare  type  of  vein  thrombosis  involving  deep  veins  and  their  tributaries.  Severe,  acute  cyanosis  and  swelling  is  due  to  the  nearly  complete  blockage  of  the  venous  system,  creating  the  blue  color  and  pain  that  give  the  condition  its  name.  It  is  potentially  fatal,  with  a  high  risk  of  pulmonary  embolism  and,  when  capillaries  are  blocked,  even  gangrene.  Treatment  of  the  condition  consists  of  anticoagulation  and  surgical  thrombectomy.  Dr.  T.  responded  to  the  treatment  and  was  fortunate  to  have  no  gangrene  or  permanent  damage  to  his  legs  from  the  condition.  He  made  steady  progress  after  the  medical  team  treated  his  thrombosis,  and  moved  to  the  inpatient  rehabilitation  unit  for  ongoing  care.  This  type  of  coordinated  care  is  effective,  with  improved  outcomes  such  as  discharge  home  to  independence  and  self-care.  After  ...