Clinical, paraclinical and interdisciplinary therapeutic approaches in a young patient with post-ischemic stroke hemiplegia (stroke), pituitary adenoma and deep vein thrombosis (DVT)

• Main Authors: Ioana Andone, Carmen Chipăruş, Cristina Popescu, Aura Spînu, Ligia Tătăranu, Magdalena Lăpădat, Gelu Onose
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2017-09-01
• Series: Romanian Medical Journal
• Subjects: hemiplegia; ischemic stroke; pituitary adenoma; deep vein thrombosis
• Online Access: https://rmj.com.ro/articles/2017.3/RMJ_2017_3_Art-09.pdf

Introduction. Stroke is a pathological condition that generates “neurological clinical signs, global or localized, of cerebral dysfunction with symptoms that last more 24 hours, having vascular origin” and it is considered the first cause of disability at global level and the second one for mortality worldwide. Stroke can determine severe or rather permanent sequels, which need, for patients' recovery and rehabilitation, important medical support. Matherial and method. This paper presents the case of a young 39-year-old patient, hospitalized at the Neurosurgery Clinic (NS) III of TEHBA for left hemiplegia and consciousness crises, and after specific paraclinical investigations (cerebral CT, cerebral Angio- MRI) is discovered in addition to the right ischemic sylvian stroke, an intracranial expansive seller and paraseller process with extension into the left ventricular sinus (pituitary adenoma). Initially, a neurological treatment and a rehabilitation nursing was performed in the Neuro-Muscular Rehabilitation Clinic Division of SCUBA until neurological stabilization, after which, in NS III Clinic, after an endocrinological control followed by specialized treatment, transsphenoidal surgery was performed, practicing subtotal ablation of the tumor. Subsequently, in our clinic, the patient continued the rehabilitation treatment. He was evaluated functionally in dynamic using the scales: Glasgow outcome scale (GOS), Rankin scale, Functional Independence Measure (FIM), Mini Mental State Examination (MMSE), Quality of Life (QOL) Evaluation, modified Ashworth scale, FAC International scale, instrumental/activities of daily living (ADL/IADL). During hospitalization, he presented a high-left deep vein thrombosis (DVT) episode that was confirmed by Doppler ultrasound, monitored by ultrasound re-evaluations and treated with low molecular weight heparin. Results. After DVT remission, the patient benefited from a complex neuro-muscular rehabilitation program, having a favorable evolution, with an increase in the scores of the evaluated scales and thus with a final performance of walking with a quad-point support cane, including climbing/descending stairs. Discussions and conclusions. The interdisciplinary therapeutic approach at a young patient with neuro-endocrine pathology, complicated by DVT, culminating with a specific rehabilitation program, results in neuro-locomotor improvements with an increase in patient’s quality of life.