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Muscular spasticity due to stroke - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Stroke
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   My dad had a Hemorraghic stroke on Feb. 3, 2010 and is now back at home. One major complaint he is saying is joint stiffness and really bad pain. First, do strokes cause this kind of pain and what can he take that will decrease this pain. He actually was on Morphean while in the hospital but he said that even didn't help totally. So what can we do to make him more comfortable?
Doctor :   Hi
Doctor :  
yes the stroke can cause pain
Doctor :  
may i know on what medications he is on now
User :   Yes just one second.
User :   Levetiracetam 500mg for seizures, Terazosin 10mg, Lopressor 50mg, Hydralazine 100mg, and Nifedipine 60mg
Doctor :  
ok
Doctor :  
can you describe the nature of the pain he is suffering from
User :   Simvastatin 80mg also
Doctor :  
ok
User :   He says it feels very achy. Like a throbbing.
Doctor :  
ok
Doctor :  
which part of the body?
User :   Says his back and his his legs are
User :   He keeps lifting his legs up like stretching
Doctor :   ok
Doctor :  
is it both the legs or only one leg?
User :   He says mostly on the right side by the thigh and his upper back right side
Doctor :   stroke was on which side of the body?
User :   Motor skills are pretty much intact but the doctors did say he is just slightly weaker on the right side
Doctor :  
ok
Doctor :  
can you please provide me the details of the ct scan of the head taken to know which part of the brain there was hemorrhage?
User :   From what I understand there was a small bleed in the Parietal Lobe area. The Neurologists did say that the location of the bleed was unusual for a high blood pressure stroke. His BP at the time of ER was 240/180
Doctor :  
ok
User :   I also think the bleed was located at the inner part of the brain
Doctor :  
is it on the right side or on the left side?
User :   My mother was saying she believes that it was on the left
Doctor :  
ok
Doctor :  
how is the limb movements on the right side now?
User :   He says its very stiff on the right side of his leg and his lower back is hurting abit.
Doctor :   the type of the pain is throbbing or burning type?

User :   He says throbbing
Doctor :  
does he have increase in the sensitivity to touch on the right side of the body more so on the right leg?
Doctor :  
like even normal touch to the part may be painful to him is it like that?
User :   He is saying it just aches doesn't really hurt when touching. He says quite abit of weakness too.
Doctor :  
ok
User :   Its sore when walking on the right side
Doctor :   what he is suffering is stiffness and the muscle pain due to spasm of the muscles of the leg as a result of stroke
Doctor :  
to be simple it is muscle soreness
Doctor :   since the stroke is of central in origin due to bleed in the brain, there will be spasticity of the side affected

User :   Okay
Doctor :   this spasticity has caused the muscle soreness
Doctor :  
the treatment of choice for him would be physiotherapy
User :   What kind of therapy is that?
Doctor :   physiotheraphy
Doctor :  
passive and active limb exercises
Doctor :  
it is stretching exercises
Doctor :  
this will relax the sore muscles and reduce the stifness of the joint also
Doctor :   you need to consult a physiotherapist for this
Doctor :  
he will initially teach the exercises to be done, latter the same can be practiced at home
User :   Okay we are suppose to schedule for pyshical therapy at a rehabilitation center at a local hospital.
Doctor :   ok

User :   The hospital threw my dad out of the hospital pretty fast. Only 2 weeks and they sent him home. Only afew 20 minutes sessions.
Doctor :   so he has already undergone one session of physical therapy which was for 20 minutes ?
User :   He has had a physical therapist and a speech therapist come in his room and work with him. He has had about 5 or 6 sessions with each.
Doctor :   that was when he is admitted in the hospital with stroke,
User :   Yes
Doctor :  
has he been to rehabilitation center following the discharge ?
User :   No, it has been since Wednesday since his discharge and no therapy has been done. He has been walking around alot and stretching on his own.
Doctor :  
good
Doctor :   the key in the recovery of any stroke is EARLY DISCHARGE FROM THE HOSPITAL and patient SELF EXERCISES assisted by the REHABILITATION CENTERS.
Doctor :   the neurological recovery followed by stroke is slow
Doctor :   it needs to be stimulated constantly,
Doctor :  
so the patient needs to be out of the hospital and out of the bed as soon as possible
User :   Okay, I'm noticing as we are talking and he is responding, he has more clear thinking.
Doctor :  
yes
Doctor :  
constant stimulation is the key
Doctor :  
this is not possible in the hospital due restrictions on the family members to be with him all the time
User :   That makes sense
Doctor :  
at home as there is more freedom and he will be talking to most of the family members there will be a constant stimulation to the brain
User :   I know the doctors were saying he was getting ICU Psychosis.
Doctor :  
yes
Doctor :  
the stroke patients will get psychotic because of hospitilization
Doctor :  
it is called ICU delirium or hospital delirium
User :   I agree. Now is stroke people more apt to have bad times during the night. He says he has terrible problems at nights.
Doctor :   sleeping problem ?
User :   Yes! He says he feels like a vampire.
Doctor :   yes
Doctor :  
it will gradually pass of by itself
Doctor :  
it usually take s 4 to 6 weeks
Doctor :  
if it still persisting than or getting more worse than treatment is required
Doctor :  
so for the first 4 to 6 weeks you can observe
User :   What do you mean by treatment?
Doctor :   keep the neurologist informed about this in the next visit
User :   Okay
Doctor :  
treatment means medicines to control his psychotic symptoms of he considering himself a vampire if it doesn't resolve by itself
User :   He goes in on March 3rd to see the Neurologist.
Doctor :   ok
Doctor :   is there anything else i can help you with?
User :   No thank you so much. Youve been a great sorce of info. This is all very new to us.
Doctor :  
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Doctor :  
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Doctor :  
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Doctor :   thanks for consulting health care magic
Doctor :  
bye for now
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