Stroke
Meta W. Williams, DO
Resident Physician
University of Minnesota
Minneapolis, Minnesota, United States
Meta W. Williams, DO
University of Minnesota
Minneapolis, Minnesota, United States
58-year-old female with Parkinson’s disease and ulcerative colitis who sustained a right basal ganglia hemorrhagic stroke during attempted left deep brain stimulator implantation, followed by craniotomy and complicated by spastic hemiparesis, cognitive, swallowing, and sleep impairments.
Case Description:
The patient, a 58-year-old female with Parkinson’s disease and ulcerative colitis, experienced an intraoperative right basal ganglia hemorrhage during left deep brain stimulator placement, necessitating emergency craniotomy for hematoma evacuation. Postoperatively, she exhibited left hemiparesis with impaired mobility, balance, coordination, cognition, speech, and swallowing requiring placed G-tube feeds. Rehabilitation admission focused on managing spasticity with botulinum toxin and orthoses, cognitive and swallowing deficits with speech therapy, and medication adjustments for sleep-wake disturbances and motor symptoms. Her care included multidisciplinary management of complex medical issues such as infection, pain, anemia, and nutritional support. Despite significant neurological impairment, goals centered on maximizing independence in ADLs, mobility, and safety during activities, addressing the unique rehabilitative challenges posed by the interplay of stroke sequelae and Parkinson’s disease.
Discussions:
Stroke superimposed on Parkinson’s disease presents unique rehabilitation challenges due to compounded motor, cognitive, and sensory deficits, requiring integrated multidisciplinary therapies. This case highlights the intricacies of care coordination in managing neurological recovery alongside chronic comorbidities such as ulcerative colitis and sleep dysregulation. Attention to spasticity control, nutrition, and neuropsychiatric symptoms was essential in optimizing outcomes.
Conclusions:
Multidisciplinary rehabilitation can achieve meaningful functional gains in patients with Parkinson’s complicated by acute stroke, underscoring the need for tailored approaches addressing overlapping neurological and systemic impairments.
