Stroke
Matison Alderman, MD
PGY4 Resident, Chief
University of Miami Miller School of Medicine/ Jackson Health System
Miami, Florida, United States
Adriana D. Valbuena, MD
Associate Professor
University of Miami Miller School of Medicine
Miami, Florida, United States
Gorav Surana, BS
Medical Student, MS2
University of Miami Miller School of Medicine
Miami, Florida, United States
Matison Alderman, MD
PGY4 Resident, Chief
University of Miami Miller School of Medicine/ Jackson Health System
Miami, Florida, United States
Significant mobility impairment resulting from generalized weakness and mild cognitive-linguistic deficits, secondary to ICU- related weakness and acute stroke of bilateral hemisphere caused by infective endocarditis, further complicated by heart failure due to a paravalvular leak.
Case Description:
68-year-old male with a history of hypertension, diabetes, and TAVR 5 years prior presented to ED with left facial droop and slurred speech. MRI brain showed acute bilateral occipital infarcts. Stroke work up also revealed infective endocarditis. He underwent a repeat aortic valve replacement complicated by complete heart block, requiring pacemaker implantation and prolonged ICU stay after which he developed generalized weakness. Rehab course significant for symptomatic fluid overload requiring aggressive diuresis while participating in the therapy program. This multidisciplinary effort positively impacted functional recovery, in 16 days patient progressed from max assistance to supervision for his ADL’s and mobility.
Discussions:
This case underscores the significance of acute inpatient rehabilitation for patients recuperating from stroke after cardiac surgery, particularly in the context of ongoing valvular disease. Individuals with neurologic and cardiac conditions frequently demonstrate reduced exercise tolerance, hemodynamic instability, and variable volume status – factors limiting therapy intensity and necessitating frequent medical intervention. The intricate management of neurological and cardiac issues can significantly impact a patient’s functional recovery, often due to limitations in exercise tolerance, hemodynamic instability, and fluctuating volume status. This highlights the necessity of a multidisciplinary medical approach, integrating therapists to customize the patient's medical management effectively.
Conclusions:
The case illustrates that each situation is distinct, and the ability to tailor rehabilitation programs to meet individual patient needs can facilitate quicker community discharge and reduce the likelihood of hospital re-admission. The patient successfully completed a 16-day inpatient rehabilitation program, achieving progression to supervision or minimal assistance for transfers, short-distance ambulation, and basic self-care, ultimately leading to a successful discharge to the community.
