Patient B is a 45 year old male who was working as a driver. He was referred to Bhagwan Mahaveer Jain Hospital on 14/09/2017 with the chief complaint of altered sensorium or coma due to binge drinking alcohol. He was admitted in ICU for emergency care. He was a chronic alcoholic. His MRI scan showed Left sided MCA infarct leading to right-sided hemiplegia or paralysis.
#stroke #paralysis #leftMCAinfarct #hemiplegia #alteredsensorium. #coma
During his ICU stay, he underwent Frontal Temporal Parietal decompressive craniotomy on 15/09/2017. He was on ventilator support, nasograstric tube for feeding and an indwelling catheter during his ICU stay. Patient showed poor awareness of surrounding environment, difficulty in functional use of bilateral upper limb and lower limb for daily life activities, dependent for ADL task, behavioral issues- non-cooperation and aggressiveness. He also had poor comprehension (wernicke’s aphasia) and poor expression of speech (broca’s aphasia), all suggestive of altered consciousness with right hemiplegia & global aphasia.
#globalaphasia #alteredconsciousness #comprehension #poorcomprehension #expressivespeech #brocasaphasia #wernickesaphasia #behavioralissuesinstroke #poststrokeaphasia. #ADL
After 1.5 months of intensive advanced neurorehabilitation, patient gradually progressed from an unconscious and restless phase to a cooperative and wakeful phase -with our WUUB program (Waking Up the Unconscious Brain). He had alcohol withdrawal symptoms because of which he was having behavioral issues and this was managed medically. His participation in rehab became better and he showed daily progress. He gained independent sitting and standing ability. His upper extremity strength improved. He was able to carry out his essential activities of daily living. He was started on the VOST protocol for prevention of aspiration pneumonia right from the ICU/ ventilator stage and he was weaned off the tracheostomy after about 2 months, as he could sustain adequate breath support and reduced secretions and his swallowing reflex had also improved. With all this, he was able to take all oral feeds without difficulty. His speech became less repetitive and more purposeful.
#WUUBprogram #VOSTprotocol #apirationpneumonia #ventilator #weaningoffventilator #tracheostomy #nasogastrictubefeeding #feedingtube #swallowingproblems. #secretionproblems #ADL #upperlimbrehab #lowerlimbrehab #upperlimbphysiotherapy #lowerlimbphysiotherapy #alcoholwithdrawal
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