Brief Answer:
Hypertensive hemorrhagic stroke

Detailed Answer:
Good evening. I'm a neurologist and am sorry that your husband suffered this stroke. Sounds like he's been having a tough time since the incident and that you've been doing your best to care for him. He appears to have had a hemorrhagic type of stroke. Often times these are due to high blood pressure problems but you say that your husband has normal blood pressure so the stroke may have been due either to his diabetic condition or it could've been due to a condition known as amyloid angiopathy which happens more frequently as we age though it is hard to prove by clinical means. The fact, that he has recovered little movement in the affected limbs also suggests to me that he stroked in an area of the brain we refer to as the subcortex or "deep white matter" possible in a place called the basal ganglia. Strokes here usually cover a large body territory such as an entire half of a person's body to include the face, arm, and leg and they are very slow to rehabilitate from.

However, you also mention that he has motion sickness and nausea comes on quickly when there is sudden movement. Therefore, I wonder if this bleed may have occurred in the brainstem area which can still affect motor function of the limbs and may have occurred in the lower brainstem area if it happened there.

He is also having trouble sitting which could represent a form of what we call TRUNCAL ATAXIA and has watery stools.

I know it seems like he may not recover much function and I understand that 9 months since the stroke without improvement is pretty good evidence that such is probably the case, however, there is something called FES (Functional Electrical Stimulation). Please take a look at this video to see what I'm talking about. FES has been at my institution since the mid 1990's and I remember ordering it on patients as long ago as even then, who had suffered strokes as much as 1 year and sometimes 2 years before I took care of them. In fact, in many cases FES centers almost prefer that the person's stroke be at least 4-6 months old before starting a program.

If you find a stroke specialist where you live and consult with them they can let you know if any FES centers exist in your area. Take a look at the video clip. It should impress you and your husband enough to want to give it a try.

https://www.youtube.com/watch?v=u5jpGOrEJkE

I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Your comment was that he was having diarrhea prior to the stroke

Detailed Answer:
In your comments up top you mention that your husband was already having difficulties with diarrhea and so forth. However, you did not specify what the cause of the diarrhea actually was so I can't help with an opinion on treating the underlying reason. However, it is quite expected and commonplace for stroke victims to have problems with continence (both bowel and bladder) and although sometimes that gets better...depending on the severity of the attack and location in the brain often times problems persist indefinitely. I believe in this case since he was already having problems with diarrhea that he has now had an insult to the brain which makes it difficult to control the bowel movements. It's not likely to be the stroke which is the cause of his diarrhea but rather it's preventing him from being able to control the sphincter as well.

There are bowel exercises that can be taught and done by patients but you will need to find a therapist well versed in that type of training technique who can work with someone such as your husband. The usual other ways of dealing with loss of sphincter control following stroke is to use BARRIER PROTECTION meaning adult style undergarments which protect outer garments from becoming soiled. Depending on the severity of the situation some of my patients use either double or either triple the protection.

Have you added fiber compounds to his tube feedings such as Metamucil, Fibercon, etc.? The problem with those types of substances is that they are not terribly compatible with tube feedings and can clog things up.

You can also check with his doctor or nutrition counselor who is responsible for the Nutren feedings to see if it were possible to use something like THICKIT in the Nutren itself which will make the feeding more viscous. Again, I don't know if you'll run into clogging problems with the tube....you may have to do a bit of experimentation.

The other thing to consider in his tube feedings is this. The HIGHER the concentration of PROTEIN in the tube feeding then, the more liquidy the material traversing the bowel and colon will be and if he's not absorbing much then, you'll have more diarrhea coming out.

If you could mobilize him more (i.e. get him to move about...or even have him moved about in different positions by physical therapy then, you will stimulate his GI tract to start functioning more normally so that it can absorb more fluid from his feedings and just leave him with a more solid type of waste product which is what normally happens in us when everything is working properly. But if we become extremely sedentary such as after a stroke and then, go on tube feedings to the stomach then, diarrhea is often the consequence.

I hope these answers satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 75 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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