Returning A Thalamic Hemorrhagic Stroke Survivor To Pre-stroke Ability

CLINICAL CASE HISTORY: 70-year-old female retired teacher presented at her home with left spontaneous decreased upper and lower limb strength and facial droop. Previous medical conditions noted are hyperlipidemia. Pertinent family medical history included mother having a stroke at 70 years old and father having a CABG at 80 years old. PHYSICAL EXAMINATION: Examination at the hospital revealed a Glascow Coma Scale of 14/15 with decreased eye opening. Neurological manual muscle testing revealed left upper extremity strength 1/5 and lower leg strength 3/5. Cranial Nerve examination revealed 7 inhibited. National Institute of Health (NIH) Stroke Scale of 12. DIFFERENTIAL DIAGNOSIS: Ischemic StrokeHemorrhagic StrokeAneurism TESTS AND RESULTS: CT: Right Thalamic Bleed hemorrhage into 3rd and 4th ventricle with surrounding edema. Blood in the left ventricle midline shift 1 cm dilation of the temporal horn of the left lateral ventricle. FINAL AND WORKING DIAGNOSIS: Right Thalamic Hemorrhagic Stroke TREATMENT AND OUTCOMES1 Month- Acute hospital management placement of external ventricular drain in the right and left frontal superior sulcus. Permanent left parietal ventriculoperitoneal shunt implanted. 2 Months- Home physical, occupational, and speech therapy. 19 Months- Outpatient physical therapy left sided hemiplegia and hemiparesis on left upper and lower extremities. 26 Months- Discharge outpatient physical therapy. Pt. has AFO on left lower leg for walking. Subjective Manual Muscle Testing Right Upper and Lower Extremities 5/5 with Left Upper and Lower Extremities 4/5. 3 years- Transition to university sports medicine clinic for cardiovascular endurance exercise, walking gait assessment, and introduction of strength and conditioning. Baseline dynamometer strength testing hamstring left to right shows 23% deficit and quadriceps 21% deficit. After 10 mo. Pt. can complete 3 miles of walking a week. Repeat strength testing at 10 mo. hamstring left to right 21% and quadriceps 8% deficit.