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Had a stroke, diagnosed with lacunar infraction in bilateral basal ganglia. Left hand lacks grip. Undergoing physiotherapy. Suggestion?

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Hi Dr. Khalidkar,
My father recently had a stroke on Sunday April 1, 2012, and is diagnosed with lacunar infraction in the bilateral basal ganglia. The full report states as follows:

--few lacunar infarct is seen in bilateral basal ganglia
--rest of bilateral cerebral hemispheres show normal morphology and attenuation pattern
--basal cisterns are normal
--cortical sulsi and fissures are normal
--lateral and 3rd ventricles are normal
--Contents of posterior fossa including cerebellum and 4th ventricle are normal

IMPRESSION: Few lacunar infarcts in bilateral basal ganglia
Suggested: Clinico- pathological correlation

He is able to move his right hand with fine motor movement like holding a pen. His left hand is lacking in grip, but can be lifted to slightly above chest level. He can now walk almost independently. He is undergoing physiotherapy now, and his dose of anti-coagulant medication has now been stopped.

Please suggest diagnosis and remedial measures asap.
Thanks XXXXXXX
Posted Tue, 22 May 2012 in Brain and Spine
 
 
Answered by Dr. Shiva Kumar R 11 hours later
Hello

Thanks for the query

From the information provided to me it looks like he had a recent onset ischemic stroke. His risk factors for stroke age, cardiac disease, uncontrolled hypertension and diabetes. Recent issue is due to uncontrolled hypertension. MRI shows small vessel disease (also called as lacunar stroke) in both basal ganglia suggesting changes due to uncontrolled hypertension.

Now to reduce the risk of stroke again (also called secondary prevention) he needs to control his modifiable risk factors like hypertension, diabetes & dyslipidemia. He needs to be on antiplatelets (Aspirin & Clopidogrel), statins (cholesterol lowering agents) along with medications for other medical problems.

So I personally request you to be in touch with the Neurologist for a regular follow up and periodic evaluation for risk factors for second stroke. He need to control his hypertension and diabetes to reduce the risk of second stroke. He requires neuro-rehabilitation in the form of physiotherapy and social support for the current stroke.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question I would be happy to address them.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
Follow-up: Had a stroke, diagnosed with lacunar infraction in bilateral basal ganglia. Left hand lacks grip. Undergoing physiotherapy. Suggestion? 15 hours later
What kind of physiotherapy do you recommend to restore left hand movement? We are planning to have him checked out in CMC Vellore. Do you think it has good facilities for this kind of issue?
 
 
Answered by Dr. Shiva Kumar R 6 hours later
Hello

Thanks for the follow up query

Regarding the physiotherapy for hemiparesis, physical therapy plays a important role in the process of rehabilitation. Physio mainly consist of passive, assisted-active and active range-of-motion exercise for the weak limbs. The facilities at CMC vellore is very good for neuro-rehabilitation and will be a good option for him.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
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