Delayed gait recovery in a stroke patient

Area of Science:

• Neurology
• Rehabilitation Medicine
• Neuroimaging

Background:

• Intracerebral hemorrhage (ICH) can lead to significant motor deficits, including impaired gait.
• Delayed recovery of walking ability after stroke presents a challenge in neurorehabilitation.
• Severe spasticity is a common complication that can impede functional recovery.

Purpose of the Study:

• To report a case of delayed gait recovery following intracerebral hemorrhage.
• To investigate the contributing factors and successful interventions for regaining ambulation.
• To emphasize the importance of addressing spasticity and initiating timely rehabilitation.

Main Methods:

• Case report of a 32-year-old female with right ICH due to arteriovenous malformation rupture.
• Utilized brain MRI and diffusion tensor tractography (DTI) to assess lesion and corticospinal tract injury.
• Implemented a multimodal treatment approach including antispastic medications, neurolysis, alcohol injections, and physical therapy.

Main Results:

• Severe injury to the right corticospinal tract was identified via DTI at 8 months post-ICH.
• Initial rehabilitation attempts were hindered by severe spasticity in the left leg and right ankle.
• Post-intervention, spasticity significantly reduced, enabling standing at 3 months and independent walking with an ankle-foot orthosis at 11 months.

Conclusions:

• Successful gait recovery was achieved through targeted spasticity management and intensive rehabilitation.
• Improvements in sensorimotor, visuospatial, and cognitive functions also contributed to functional ambulation.
• Clinicians should investigate causes of gait impairment and initiate prompt, intensive rehabilitation for non-ambulatory stroke patients.