Conference Proceeding - Restricted Access
PM & R
Case Diagnosis: 67-year-old female with left hemiplegia due to right ACA CVA with hemorrhagic conversion Case Description or Program Description: Patient presented from home to IPR. Three months prior, she had a right ACA CVA, first noticed due to dizziness and left leg weakness which resolved on presentation. NIHSS 0. CT perfusion only showed a small area of reversible ischemia in the medial right upper lobe vertex region. That evening, she had left leg weakness again, with NIHSS 4, given tPA. Imaging showed evolving acute infarct in the right ACA territory with interval development of hemorrhagic transformation. She then presented to IPR, where she had left hemiplegia and cognitive deficits. Before her second stay in IPR, she gained strength in her LUE (previously paretic), which enabled her to improve functionally with therapy. She also had marginally improved cognition but was found to have affective dysregulation/pseudobulbar affect during her second stay. Setting: Inpatient rehab facility Assessment/Results: Patient’s Care Tool Score improved from 30 to 45 on initial admission and 48 to 50 on the subsequent admission. Before IPR, she was max assist to dependent for all functional assessments. During her first stay in IPR, she was dependent for bed mobility and transfers, unable to ambulate, with max assist for upper/lower extremity dressing. Upon completion of her second stay, she was standby to moderate assist for bed mobility and transfers, ambulated 10 feet on the parallel bars with moderate to max assist, with supervision for upper extremity dressing and max assist for lower extremity dressing. Discussion (relevance): Patients do not often present from home directly into IPR without new deficits. This case can help argue for the benefit of further IPR after patients gain more function as well as for more in-depth neuropsychological testing for CVA patients. Conclusions: Patients with CVA and neuropsychological sequelae may benefit from admits to IPR from home. Level of Evidence: Level V
Fry A, Ho J. Late sequelae of CVA patients: an admit to IPR from home. PM&R. 2022 Oct;14(S1):S106. doi: 10.1002/pmrj.12913.