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Abstract: The patient had left-sided hemiplegia with left-sided limb sensory impairment due to cerebral hemorrhage 1 year ago. After treatment, he was considered to have hemiplegia, and the limb dysfunction was caused by improper rehabilitation. By giving medication and guiding rehabilitation training, the patient’s condition was stabilized and his symptoms improved.
Basic information】Male, 66 years old
Disease Type】Heparesis
Hospital】Shandong Provincial Third Hospital
Date of Consultation】May 2021
Treatment plan】Medication (baclofen tablets, aminophen dihydrocodeine tablets)
Treatment Period】7 days of inpatient treatment, 1 month of outpatient follow-up
Effectiveness】Stable condition and improvement of symptoms
I. Initial consultation
The patient came to the clinic in a wheelchair with a painful expression. The patient’s family described: 1 year ago, he was left with left-sided hemiplegia, decreased muscle strength, and numbness of left-sided limbs due to cerebral hemorrhage. After being hospitalized for a period of time, his condition improved, and after being discharged from the hospital, he continued to take medication and insisted on daily rehabilitation exercises. However, in the past 3 days, he experienced pain in the limbs, stiffness in the joints and inability to walk, and a significant decrease in strength. He was worried that the cerebral hemorrhage had recurred, so he came to the outpatient clinic. Neurological examination: left limb muscle strength grade 3, high muscle tone, positive pathological signs, outpatient preliminary diagnosis: hemiplegia. Further cranial MRI was recommended to rule out any new cerebral hemorrhage. The patient’s family expressed understanding and actively cooperated with the examination.
(Cranio-cerebral CT)
II. Treatment process
The patient was arranged to be admitted to the hospital to improve blood sampling and laboratory tests for routine blood, liver and kidney functions, ion, lipids, blood glucose, and cardiac enzymes, etc. The laboratory results suggested that: blood glucose and lipids were high; electrocardiogram and lung CT did not show any significant abnormality; the review of cranial magnetic resonance examination suggested that there was no new occurrence. The patient was asked about the number of training sessions at home, the training time was longer, and the training was mainly up and down the steps and walking. The patient was given baclofen tablets to relieve muscle tone and aminophenedihydrocodeine tablets to relieve pain. He was also given muscle massage and acupuncture and physiotherapy. The patient was discharged after 7 days of hospitalization and improvement, and was advised to follow up with the neurology and rehabilitation outpatient clinics after half a month, which requires standardized rehabilitation training to help the recovery of the disease.
III. Treatment effect
After admission, the patient was given baclofen tablets to relieve the increased muscle tone and aminophenedihydrocodeine tablets to relieve pain, and the symptoms of limb pain and joint stiffness improved significantly. On the third day of hospitalization, the patient could walk with crutches. Correct massage and massage of the limb muscles was given, and instructions were given that rehabilitation exercises should be performed in stages five times a day, each lasting about 30 minutes, with no significant muscle soreness as the upper limit of labor intensity. The items of rehabilitation work included: going up and down steps, squatting, walking in a straight line, etc. After 7 days of hospitalization, the patient’s symptoms were completely relieved and the limb muscle strength was assessed at level 4, which was significantly improved from before. One month after discharge, the patient was followed up by telephone with no special discomfort and adhered to the rehabilitation training.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but because hemiplegia belongs to the sequelae of intracerebral diseases and is related to brain cell damage, the patient needs long-term rehabilitation training to gradually improve limb function, and rehabilitation training should be standardized to avoid adverse symptoms. For rehabilitation training should follow the principle of gradual progress and avoid long time and high intensity exercise. If pain, swelling and abnormal mobility of the limbs occur during the rehabilitation exercise, it is recommended to consult a doctor promptly. After discharge, pay attention to low-salt and low-fat diet, monitor blood pressure, blood glucose, blood lipids and other indicators, and actively control them.
V. Personal insight
Hemiplegia manifests as weakness of the lateral side of the limb, decreased muscle strength, and a paralyzed position. It is commonly caused by intracerebral lesions, such as cerebral infarction, cerebral hemorrhage, and encephalitis, and the sequelae are signs of neurological dysfunction caused by ischemic necrosis of brain cells. In general, patients with physical dysfunction after the disease will feel very anxious and will involuntarily increase the length and intensity of rehabilitation training in the early stage, hoping to recover early. However, rehabilitation training is a gradual process that requires a comprehensive assessment based on the patient’s own strength and function, and a gradual increase in intensity, which can be counterproductive if increased blindly, as in the case of this patient. In conclusion, family members should pay more attention to the patient’s limb function and bring the patient to the hospital for regular follow-up, which is beneficial to the gradual improvement of the disease.