tremor and fevor

[bournonville]

My sister age 46 had a stroke on the 23rd of May. She received TPA which did not dissolve the clot and had to be airlifted to a very good regional stroke center. She underwent a merci retrieval which successfully removed the clot but just within the important six hour limit of treatment.

Since the clot removal she has been lethargic, had brain swelling that required a section of her skull to be removed to relieve the pressure.  She has had intevals where she is more alert but but very lethargic.  But she had made enough progrees to go from the ICU the CCU.   She has now developed a high fever and blod clots in her arms and legs and has been readmitted ot the ICU and is being administered a low dose of heparin to thin the blod so the clots don't grow and so that hopefully over time that we be absorbed by the body. She has a greenfield filter. She also has a stomoch pic (S?) to provide more food than she was geting form the feeding tube in her nose.

On readmitting her to the ICU she started presenting with what the nurse described as seizures, but which appear more like tremors and only on the left side, the side affected by the stroke.  She is very lethargic.

We don't know what to think at this point. Its two weeks out so its hard to know if we are in the woods, emerging, or being overwhelmed by the woods. Does any of this sound familiar?

Pat

[deeneezy]

Hi pat,

As a student nurse i spent 12 weeks on  a stroke rehabilitation ward and saw many patients who were all affected in many different ways from having a stroke.

Stroke is such a complex thing that can affect any part or any function of the body, and it is nearly impossible to predict how the person who has suffered from a stroke will recover.

When you speak of the 'stomoch pic' you may mean the stomach peg? is it a tube that goes directly into her stomach just above her naval? She will have this most likely because her gag reflex is no longer effective when she swallows, this would put her at risk of aspirating food (food going into the lungs) and can cause pneumonia. So this is why she will be fed in this alternative way, the peg will also alow them to give certain medications aswel. This is a very common thing in stroke patients.

This tremor she has down her left side can be seen when suffering from siezures, as i have seen this in stroke patients before, however, i do not fully understand why she may be experiencing the siezures.

The heparin that your sister is on is a very important part of her treatment. Whilst ever she is at risk of blood clots she will need some form of anti-coagulant (anticlotting) medication such as this. The heparin will treat the clots that are there and also help to prevent new clots from forming. The reason this is so important is because her stroke will have most likely been caused from a clot in the first place. (the other way is a bleed)

I have seen that it is very difficult to see a family member that has suffered from stroke, especially because it can happen to someone who appeared to be very healthy and independant and all of a sudden the stroke took this away from them, these can lead to feelings of anger and frustration, it is such a severely disabling thing. Allthough this does not mean that your sister will not recover at all, I would imagine that the most important thing is for them to deal with these blood clots at the moment, so that your sister will have a better chance at recovering.

You may of already known most of this, but i thought to have a bit of a better undertsanding about something makes it easier.
If you stil feel like you don't understand what is going with your sisters treatment, especially with the siezures, request to speak to the doctor on the ward, who will be able to explain more to you.

I wish your sister wellness. Try to remain positive, i know this must be difficult for you.

Denise x

[bournonville]

thanks so much for your fast response. Yes, it is a peg.  She had one before but they took it out when the fever developed in case that was the source of infection.

I guess what I am trying to figure out - and will ask at the hospital later this morning - is how much my sister's post op issues are part and parcel of what happens post op i.e. have they seen the things that are going on with some frequency or not often.  And is all this an indication of deterioration or just any number of things that are things that are dealt with post op.

Her vitals are very good, but as note in my original post she is now very lethargic.  This morning we are going to review the result of an test to review her brain function that was ordered last night.

Thanks again.

Pat

[Luckylinn]

My prayers and thoughts are with you. I too have a sister who suffered a stroke on 2/9/09 at the age of 30. Hers was a hemorrhagic stroke. They went in and did surgery to stop the bleeding. She came out of the surgery ok, and that is when it all started going down hill. She spent 25 days lethargic, would occasionally open her eyes but didn't "see". She developed an infection on her surgery (MRSA), meningitis and other complications. She had a peg, and a pic line which they used to give her antibiotics. 35 days after it all began, she finally "woke up". She was unable to talk, walk, eat, you name it. Here we are 4 months later and by the grace of God, my sister can eat unassisted, she can talk, although very slurred, and she is learning how to walk. We see progress every week and although it is slow, we are hopeful. I hope this more than anything gives you some hope. It is very difficult to go through this, but knowing you are not alone is helpful. It is my believe that my sister pulled through because of our constant prayers.

God Bless You
-Luckylinn

[Chasnsx]

My Dad, age 74, had a hemorrhagic stroke near the base of his brain.  At the beginning, he was not expected to survive.  He was on a ventilator for two weeks, and unconscious for a month before he woke up.  He ran a fever for two weeks, and had gram negative coccus pneumonia.  Now, almost six weeks out, he can maintain consciousness for most of the day, and is in physical therapy and is making daily progress.  His only paralysis is in his right hand.  He is gaining strength in his left hand, neck and legs.  He still has a trach tube, a g-tube and a catheter.  The speech therapists are trying the Passey-Muir valve, but no progress yet, possibly due to leftover congestion.  I never knew just how tough Dad was until I saw him fight so hard for his life.

[bournonville]

Thank you so much for your responses.  Given the huge challenges that you and your family members have been dealing I am happy to hear of the hard fought for success that has come after so much scarey time.

As a result of the lethargy and loss of appropriate responsiveness the Dr. moved my sister back to ICU. The scan they did showed a building up of fluid and pressure under the closed part of her skull.   The Dr. said they would need to drill bore holes or do another bone flap or order to drain the fluid.  She had the proceedure and they only had to do the bore hole procedure and her vitals are still good.  The Dr. said he was encouraged because the brain responded well and expanded back into the space in a healthy manner.  We are hoping that this will return her to the level of responsiveness she had previously.

Again, thank you so much for your repsponses.  If anyone themselves or someone they know has gone through the bore hole treatment I would be interested to hear how that affected their recovery.

Pat

[bournonville]

I wanted to let those who read my postings on my sister that she has undergone an improvement.  The bore holes that relieved the pressure on the closed side of her skull seemed to serve as a catalyst for a marked lessening of lethargy.  Her eyes stay open for fairly long periods of time and she has responded with short but cogent sentences.

She was moved yesterday to rehab, 24 days after the stroke.  Her complications delayed the beginnign of rehab.  Her significant challenge right now is a swollen leg due to a clot that they are dealing with very carefully as her surgery was six days ago.  I know her doctor want to get her on heparin therapy as soon as it is medically adviseable.

She still had the paralysis on the left side, but she really hasn't had any therapy yet.

You were kind enough to review and encourage me before. I wanted to let you know that she is doing better but has a very long way to go.

Patio