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Fully Functional Recovery after Brainstem Infarction in a Young Patient- A Case Report

Article Information

Pengyu Huang1#, Dandan Lu1,2#, Haixia Lu1*

1Department of Neurobiology, School of Biomedical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, China

2Rehabilitation Department of Traditional Chinese Medicine, East District of the 1st Affiliated Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, China

#Those two authors contributed equally to this work.

*Corresponding Author: Haixia Lu, Professor, Department of Neurobiology, School of Biomedical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, China.

Received: 14 October 2022; Accepted: 02 November 2022; Published: 25 November 2022

Citation: Pengyu Huang, Dandan Lu, Haixia Lu. Fully Functional Recovery after Brainstem Infarction in a Young Patient- A Case Report. Archives of Clinical and Medical Case Reports 6 (2022): 741-746.

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Abstract

Ischemic brainstem infarction is extremely rare in the young people under 30 years old but with severe symptoms and poor prognosis. It is commonly caused by stenosis and occlusion of the vertebrobasilar artery and its branch vessels. Here we reported a 26-year old male brainstem infarction patient with severe hemiplegia and dizziness on admission. He has no hypertension, obesity, diabetes and other chronic diseases, which are the most common reasons for infarction, but has a long history for smoking and drinking. Immediately after acute drug therapy for circulation improvement, he received personalized treatment with drug medication plus physical rehabilitation. The myodynamia, motor balance and living ability fully recovered 5 months later. This case leads us to call for more attention to brainstem infarction patient younger than 30 years in the hope for new strategies for both diagnosing and treatment.

Keywords

Brainstem Infarction; Hyperhomocysteinemia; Rehabilitation; Youth

Brainstem Infarction articles; Hyperhomocysteinemia articles; Rehabilitation articles; Youth articles

Article Details

1. Introduction

Ischemic stroke accounts for 85% of all strokes. It is one of the most common cerebrovascular diseases and characterized by high incidence, morbidity, and mortality [1-2]. Stroke has become the major cause of disability and the second leading cause of death in the world [3]. Stroke in people younger than 45 years is less frequent than in older people but has major impact on the individual and society. Due to various factors, the proportion of stroke in adolescents and young adults (aged from 18-50) has increased to approximately 15%-18% in recent years [4,5]. Patients in this age are almost in a critical period of life when important decisions should be made on starting a family or a career. It also remain at high risk for recurrence [6]. Therefore, close attention should be made for the therapy of young patients and the functional recovery is urgently required. Ischemic brainstem strokes constitute about 10% of all ischemic brain strokes. Patients with brainstem strokes may experience minimal functional or cognitive deficits, or devastating injury. A patient under 30 years old and with severe motor deficits after brainstem infarction could fully functional recovered is extremely infrequent. We outline the patient’s hospital course and eventual improvement here is for calling more attention to brainstem stroke in young.

2. Case Presentation

A 26-year old man with sudden right-sided hemiplegia and dizziness was admitted to hospital. On admission, he was diagnosed with brainstem infarction based on the image of CT scan and extremely high level of homocysteine (71 μmol/L). He denied for the history of hypertension, diabetes, coronary heart disease or other chronic disorders and felt perfectly well before the symptoms occurred. He has been smoking for over 8 years with 10-15 cigarettes per day and drinking 4 to 6 bottles of beer daily for over 7 years. Physical examination showed the lower myodynamia on right arm and leg. Muscle tension of right limb was normal. He lost balance when made a move and the ability of daily life decreased dramatically (was in moderately dependent). No cognitive deficit was noticed and all the reflex were normal. After admission, he received 12 days treatment with anticoagulants, vasodilator and neuroprotective agents to improve the circulation and enhance collateral circulation establishment. As soon as finishing the acute treatment, function rehabilitation training was admitted (Table 1). The initial treatment effect was noticed by Brunnstrom stage 20 days later and the decrease of homocysteine level (59 μmol/L) was observed 3 months later. Five months later, the myodynamia of right limb, the balance (showed by Brunnstrom stage and Berg Balance Scale, Table 2 and supplement) basically recovered to normal levels. The ability of daily living (showed by Barthel Index, Table 2 and supplement) recovered to almost independent. The homocysteine level reversed to 27 μmol/L.

Table 1: Personalized Rehabilitation Training Strategy

Drug Medication

Butylphthalide

0.2 g, t.i.d.

Folic acid

0.8 mg, q.d.

Mecobalamin

0.5 g, t.i.d.

Physical Rehabilitation

Acupuncture

q.d.

Electronic biofeedback

q.d.

Hand function training

q.d.

Hemiplegic limb comprehensive training

b.i.d.

Balance function training

b.i.d.

Endurance training

b.i.d.

Table 2: Brunnstrom stage, Berg Balance Scale and Barthel Index

Evaluation Period

Brunnstrom stage

Berg Balance Scale

Barthel Index

Upper Limbs

Hand

Lower Limbs

On admission

II

II

III

29

55

50 days after

III

III

III

33

60

120 days after

44

85

3. Discussion

Stroke patients younger than 50 may have etiology varies [7]. According to the traditional TOAST classification of stroke, the patient we reported here could be classified as stroke of undetermined etiology [8]. Based on the risk factor classification given by International Pediatric Stroke Center [9-11], the long history of excessive alcohol consumption and cigarettes smoking might be the main etiology for this 26-year old ischemic brainstem stroke patient. In addition, existed data showed that hyperhomocysteinemia may be risky for ischemic stroke [12-13]. Accordingly, we noticed the homocysteine level of this patient is far beyond the normal value (0-20 μmol/L) and the treatment with folic acid tablets and methylcobalamin capsules was quite successful. The treatment of brainstem infarction mostly relies on drugs and works poorly in most cases. For stroke in young, function recovery is critically required. Therefore, a personalized rehabilitation training was given to this patient immediately after acute treatment and last for 4.5 months [14-17]. An optimistic result, including the regain of postural balance and ability of daily life as well as the reverse of homocysteine level was achieved. In summary, stroke in young patient requires different approach to investigate and management. The recovery from stroke in young patient is quicker and better than that for older adults. To our knowledge, this is the first report of ischemic brainstem stroke in patient younger than 30 years. Our experience leads us to call for more cases and new strategies for diagnosing and treatment of stroke in lower age.

Funding

This research was partially supported by the National Nature Science Foundation of China (Grant No. 81870981 and 82171389).

Disclosure

All authors declared no conflict of interest.

References

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