Case Study – Vestibular Artery Stroke

February 26, 2019 | By | Reply READ MORE...

A 43 year old female came to the clinic with following complaints:

  • Difficulty in maintaining balance while walking.
  • Frequent falls. No voluntary control over walking.
  • Inability to perform her daily activities: like bathing, rising from the floor, toileting activities.
  • Coordination issues: especially eating and writing.
  • Memory issues, difficulty in thinking and understanding. Difficulty in following commands.
  • Speech: difficulty in speaking, sudden increase in pitch while talking. Problems with drinking water or swallowing food.
  • Visual affection: peripheral vision of left eye is affected.

HISTORY:
History of stroke 8 months back. She complained of severe headache followed by episodes of vomiting. She also got a seizure attack. Was admitted in the hospital for 2 and half months and was treated surgically (brain shunting was done).

CLINICAL EVALUATION:

  • Dependent on an aid: Entered the clinic with a walker. When made to stand without walker swayed back and forth.
  • Balance evaluation: She stood with her weight shifted entirely on the left side. Her body tilted to left even in sitting. Sitting with eyes closed was difficult. She had a fear of losing balance. Sitting on the chair and getting up was difficult. Needed assistance.
  • Motor assessment: Muscle strength poor. Her grip wasn’t strong. Also she had a general loss of strength in both her arms. She was breathing faster. So was getting fatigued frequently.
  • Coordination: Severely affected. Alternate hand movements affected.
  • Long term memory loss. Had forgotten few special moments of life. Also had difficulty in reading. Would lose out on words and hence conversing had become a big issue.
  • Vision: Her peripheral vision was affected. Difficulty in focusing on an object (we used a pen for reference). Nystagmus (rapid involuntary eye movements) present in both the eyes.

What is the function of vestibular artery and which areas does it supply?
The vertebral also known as vestibular artery is one of the main arteries at the base of the neck. It majorly supplies the brain stem. (Medulla Oblongata, Midbrain and Pons). Later it unites to create a basilar artery which supplies midbrain, thalamus and occipital cortex. It controls basic body functions such as breathing, swallowing, heart rate, blood pressure. Also it is responsible for coordinated bodily movements, example: hand swaying while walking, eye hand coordination. It also controls the speed of walking and sends signal to the brain when one has to stop.

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The image is taken from Wikipedia.

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Taken from https://www.earthslab.com/wp.

PLAN OF CARE:

  • Improve activities of daily living. Neuro development techniques like segmental rolling, supine to sit, kneeling to half kneeling to standing were taught to the patient. Bottom shuffling on the bed, sit to stand in correct pattern helped her get a good control to stand up from chair.
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  • Balance training: This included walking around the cones. Stepping up and down the stepper. Kneeling on the foam pad and reach outs.
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  • Coordination exercises : This included walking with alternate hand movements. Upper limb strengthening with half kg weighted ball. Core strengthening.
  • Visual training. VOR exercises , gaze fixation exercises to improve her peripheral vision.
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  • Memory building games , puzzles to improve her cognition.
  • Speech therapy. She was asked to sing her favourite songs.
  • Behavior therapy for anger management.

 

Today she is able to get up from the floor without assistance and walk, which she wasn’t able to earlier.

She walks with alternate hand movements. Walking is better but still has some fear of falling. Her hand grip has improved, can eat on her own and can also write a few sentences.

Does all daily activities independently.

Needs supervision in outdoor activities.

She is still undergoing therapy with us.

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Category: Case Studies

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