Authors:
Gadiza Raiznintha P
and
Ditaruni Asrina U.
Affiliation:
Universitas Airlangga, Indonesia
Keyword(s):
Intracerebral hemorrhage, hypertension, dysphagia, cognitive disturbance, rehabilitation
Abstract:
Intracerebral hemorrhage is a type of stroke with rupture of the small intracerebral arterioles causing bleeding directly into the brain parenchym. The most common cause is hypertension leading to damage of the arterioles. The degree of damage depends on the location, rapidity, volume, and pressure of the bleeding. We reported a female, 51 years old, diagnosed with intracerebral hemorrhage who underwent craniotomy and evacuation surgery. It was a secondary stroke attack with uncontrolled hypertension as a risk factor. She had decrease of conscioussness (the worst GCS was E2V1M4) for 16 days, right hemiparesis with MMT 0/5, hospital acquired pneumonia with active mucous production, and second grade pressure ulcers in the sacral region. The acute phase of physical medicine and rehabilitation (PM&R) programs were proper positioning, turning every 2 hours, postural drainage and chest physical therapy, and passive range of motion exercise. On the 17th day, there was improvement in conscio
usness (GCS E4V5M6), pneumonia, and pressure ulcers but there was still no improvement in muscle strength. The next discovered problems were dysphagia, dysarthria, and cognitive disturbance. The subacute phase programs were feeding therapy, breathing exercises, articulation exercises, and audio-visual-tactil stimulation. The patient was discharged after 38 days of hospitalization. At the next month follow up, the dysphagia was improved, she could do simple activities such as eating, grooming with left hand substitution, and sitting properly without leaning. In conclusion, early PM&R intervention gives some benefits for the management of intracerebral hemorrhage with various complications. Comprehensive long-term multidisciplinary management is needed to ensure optimal improvement and prevent further attacks.
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