I saw a patient today who had a stroke (right hemiplegia) 2 years ago.
It appears that he did not have lot of muscle weakness at the time
of the stroke and now his main complaints are poor balance and
decreased sensation in this lower leg and foot.
>From the assessment he seems to have two main problems:
1) Impaired lower leg sensation especially light touch but also
proprioception to a lesser extent.
2) Dizziness (ie. the room spins) brought on by:
-extending his head in sitting or standing
(unable to do so in standing)
- turning his head from side to side especially if he moves fast.
He walks independently but is a little unsteady and uses a cane outside.
His standing balance is poor with a tendancy to lean back and he is
very dependent on visual feedback.
His muscle strength is almost equal bilaterally but he has slight weakness
in the right lower limb especially in his dorsiflexors.
Becuase of the dizziness I suspected vestibular problems and crudely
checked the vestibular occular reflex- when he turns his head from side
to side he wasn't able to maintain a fixed gaze.
My questions are;
1) Does this sound like a vestibular problem or have people seen
similar patterns of dizziness in people with cerebral hemisphere
stroke?.
2) If so this would mean he would have had to have a brainstem stroke
(a CT has not been done) and would this fit with his other symptoms of
sensory loss and mild weakness (I think that would mean it would have
had to have affected the ascending and descending fibres and either the
vestibular nuclei or vestibulo spinal tract).
Sorry this note is so long.
I'd appreciate any thoughts/ideas on these issues.
Thanks,
Rhona Thornton
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