Rehabilitation after spontaneous pons-mesencephalon cerebral bleeding

A. M. an_mo at yahoo.com
Tue Dec 11 21:13:57 EST 2001


I am posting the following message on behalf of a friend. 

We would like to get information regarding neurologists, hospitals or
institutes/centers for the rehabilitation of 34 years old man with
spontaneous pons-mesencephalon cerebral bleeding in the right
hemisphere.

My name is Chiara Cerin from Vicenza (Italy).
On June 30th 2001 my brother (34 years old) had a spontaneous
pons-mesencephalon cerebral bleeding in the right hemisphere.
Fortunately he was inside the local hospital (Ospedale San Bortolo di
Vicenza) at the moment of the occurrence, so immediate assistance was
provided.
Our request for help is the following: 
-Is there a neurologist who has experience with bleeding in the brain
region occurred to my brother?
-Or who would be willing to follow and care of the evolution of his
clinical situation (see following summary)?
My brother and we from his family are willing to go everywhere for a
consult.

Here is a summary of the release letter on 10/16/01 by Dr. Sensi: the
CAT indicated bleeding of the trunk with invasion of the fourth
ventricle and inferior colliculi. The patient was sent to the
intensive care unit and a tracheotomy performed; surgery was not
performed because CAT on 07/03/01 didn’t show worsening signals
and excluded hydrocephalon. Neurological conditions were improving so
that on 07/08/01 he was transferred to the Neurology Department: he
had a light left partial paralysis, ataxia and right cerebellum
dismetria, dysesthesias of the left hemisoma, deficit in extrinsic
ocular movements, hypophonia and disphagia for liquids. The CAT on
07/09/01 indicated an re-absorbing process of the bleeding. An
orthoptic test indicated deficit on both lateral rectus. On 07/24/01
the patient was transferred to the Rehabilitation Department: he
presented partial paralysis of the left side with strong cerebellum
problems on the right hemisoma and diplopia; he was able to performed
posture passages by himself, his words were dysarthric but
comprehensible. Cognitive problems (such as sustained attention,
verbal executive functions, ideomotor apraxia, utilization apraxia),
deafferentation pains (algic-dysesthesic sinthomatology) with dystonic
tremors at the right limbs, and reactive depression were serious
obstacles to the rehabilitation process. These problems were treated
with Neurontin, that had to be gradually decreased in dosage because
of its side effects.
The evolution of the clinical process has been slow and gradual.
Among the many tests:
-Cerebral NMR on 08/08/01: indications of previous bleeding lesion at
the right mesencephalon, laterally and posterior to the aqueduct, and
extending to the posterior portion of the pons up to base of the
fourth ventricle. A small hypo-intense lesion with a hyper-lucent
center was visible at the left semioval center. Two cavernous angiomas
are present, one of which in the mesencephalon with traces of recent
bleeding.
-Angio-MR (same date) doesn’t show either size anomalies or
process anomalies.
-Neurosurgery consult on 08/20/01: no surgery indications.
-PET on 09/28/01: strong cortical and subcortical hypometabolism of
the left hemisphere.
-Lancaster test on 09/29/01: a satisfying prismatic correction is not
possible.
We had good responses to the painful dysesthesias of the right arm and
mood using Fluoxetine and Amitriptiline. Disphagia hasn’t
improved.

On October 16 2001 my brother was released from the Vicenza hospital
and transferred to Physio-kinesi Tehrapy Unit at the hospital of Schio
(province of Vicenza) to attend a rehabilitation protocol with Dr.
Perfetti. My brother responds to the rehabilitation program, but in
the last weeks an increase of tremors at the left leg and an increase
of his dysarthria are serious obstacles in performing the
rehabilitation protocol.
More NMRs were done (that I don’t have at hand now), showing
complications of the neurological situation. A neurosurgery
examination confirmed that surgery can not be performed.

Our request for help is: is there a neurologist who has experience
with bleeding in the brain region occurred to my brother? Or who would
be willing to follow and care of the evolution of such a clinical
situation? My brother and we from his family are willing to go
everywhere for a consult. Dr. Perfetti himself agrees to collaborate
with a neurological equipe in order to formulate the right therapy for
my brother.
Whoever can offer useful information or wants to know more about the
case, can contact me and I can then put him/her in contact with Dr.
Perfetti.

Thanks for your time
Sincerely
Chiara Cerin
c_cerin at freemail.it or f_magrin at libero.it




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