Shamma Khamis Al-Jabor-Sequel of Cerebral Hemorrhage-(Qatar)-Posted on May.20th, 2015

Name: Shamma Khamis Al-Jabor     
Sex: Female
Country: Qatar
Age: 59 years
Diagnosis: 1. Sequel of Cerebral Hemorrhage 2. Hypertension 3 level 3. Sleep apnea syndrome 4. Impaired glucose tolerance    
Date: Apr. 16th, 2015
Days Admitted to Hospital: 20 days

Before treatment:
The patient felt dizzy and experienced headache 7 years ago when she doing house work. She fell and lost consious. She was taken to a local hospital and was diagnosed as cerebral hemorrhage after full examinations. She had clearance of hematoma and woke up 1 week later, but she couldn’t speak or move. Her condition was stable 2 months later. She went to Germany to have recuperatory therapy. She could speak somewords and move 4 moths later, but she couldn’t move the right side of her body. She went back home. She had impressive aphasia 6 years ago. She couldn’t move her right upper limb freely. She coud walk by herself and could care for herself sometimes. Her family wanted her to have a better treatment so she came to our hospital.

Her emotion was unstable. She easily get irritated. Her diet, urination and defecation were normal. She couldn’t sleep well because of pain in her right lower limb.

Admission PE:
Bp: 134/83mmHg; Hr: 68/min. BT: 36.4 degree, RP: 16/min. Height: 162cm, weight: 82kg. She was well nourished and obese. The skin and mucosa were with no yellow stains or petechia. There was a 2*2 cm surgery scar on the right forehead. Her gait was abnormal. The respiration of both lungs was clear, with no dry or moist rales. Her heart rhythm was normal and strong, without obvious murmur in the valves. The abdomen was bulge and soft. The liver and spleen were normal. There were white patches on the distal of both lower limbs. There was no dropsy on both lower limbs.

Nervous System Examination:
Shamma Khamis Al-Jabor was alert and her spirit was not good. Her depression was unstable, easily get excited and also had a bad tempered. She had combined aphasia. She couldn’t count numbers normal. Her memory, calculation and orientation abilities were slow. The diameter of both pupils was 3.0mms, and both pupils were equal in size and round. Both eyeballs could move freely and the pupils reacted normally to light stimulus without nystagmus. The forehead wrinkle pattern was symmetrical. The tongue was a little to the right, her teeth and angulus oris were a little to the left. The muscle power of left side was at level 5, the muscle power of right distal upper limb was at level 3, right proximal was at level 3-. The grip of right hand was at level 3. Her right hand had dyskinesia. The muscle power of right lower limb was at level 4. The extension of right foot was little slowly. The muscle tension of right upper limb was a little higher. The tender reflex of right side was a little overactive. Both side abdominal reflexes were abnormal. Both palm jaws reflex were positive. Right side Hoffmann sign and Babinski sign were positive. Left side pathology sign was negative. The rough depth determination of right side was weaker. The finger-to-finger test, finger-nose test and rapid rotation test of right upper limb were done in difficulty. Right side heel-knee-tibia test was slowly done. Left side coordinate movement was normal. The meningeal irritation sign was negative.

Treatment:
Shamma Khamis Al-Jabor received treatment for nerve nutrition, improving blood supply, stabilizing blood pressure and controlling mood. She had sleep apnea syndrome, so she used non-invasive ventilator for breath, pattern ST, PI 11,
PE 4, BR 12. Her blood glucose was 6.8-9.9mmol/l, so she had oral glucose lowering to improver her blood glucose.

Post-treatment:
After the treatment, her blood pressure and blood glucose were stable. The oxygen saturation was 96-98% during sleeping. Her nervous system function was better, she could speak more clearly. When she counts numbers, she loses less numbers. She was in stable mood. The pain of right lower limb was less. The right hand grip was at level 4. The muscle power of right lower limb was at level 4+. Her gait was better, she could take care of herself better.