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Thread: Suspected Spinal Stroke

  1. #1

    Suspected Spinal Stroke

    My almost 78 yo active father had a 'suspected spinal stroke' 2 days ago. We are still awaiting confirmation of diagnosis. His symptoms started with cold feet and within 24 hours progressed to complete paralysis from the belly button down. He has no feeling or movement whatsoever. He has had a barrage of tests, including microbiological, of which we are still awaiting the results of. They initially thought it might be shingles because he has a rash around one side of his midriff, and although I haven't seen it for myself, my mum tells me that it doesn't look like a shingles rash - she has had shingles and is aware of how it looks. He has had scans (I'm not sure if MRI, I didn't think to ask the dr yesterday when we spoke - still in too great a state of shock to ask competent questions - but I would assume so) and x-rays which show no compression of the spinal cord. He has also had a nerve conduction test, which, apparently, shows conduction consistent with stroke. He is currently catheterised and he has a long term colostomy, so voluntary bowel function is non-existent. The neurologist he saw today gave him a pretty poor prognosis (but still no diagnosis), saying that he didn't expect him to regain any function whatsoever and mentioned nursing home care as my mum would be unable to care for him in terms of lifting etc. He has been given methylprednisolone daily since onset, however, I can't remember the dosage, along with anti-virals and antibiotics. He is now in no pain.

    My question is was the neurologist's prognosis fair? Granted, his symptoms seem consistent with spinal stroke, but I feel he was a bit premature to cast no hope. What has been others' experience of regaining function and should we have already started to see some gain of function?

  2. #2
    It is way too early to tell. Rule out diagnoses at this point should be TM (transverse myelitis), spinal stroke, and spinal cord abscess. The latter can be ruled out with an MRI and would require immediate surgery if it exists. The other two are generally diagnosed by symptoms and no other diseases or conditions being present that would explain them.

    With both TM and spinal cord stroke it is common to get some return, esp. sensory, although how much is variable, and he is unlikely to have full return. Otherwise, your father needs acute rehabilitation, not just to be sent to a nursing home. Is he a military veteran by any chance?

    While your mother may not be able to lift him, unless he was already in poor shape, he should be able to learn in rehab how to do an independent or nearly independent transfer, and if not, then a mechanical lift would be appropriate, no matter who provides his care. Do your parents have the financial resources to hire in help part-time at home? He certainly would not need around-the-clock care and it would be much better for him to be in a home setting. A nursing home will be a death sentence for him at his age with a SCI.

    It is critical right now that everything is being done to prevent pressure ulcers. Hound the nursing staff about turning him faithfully at least every 2 hours 24/7, get him onto a specialty pressure reducing mattress (low air loss is best) and learn how to and inspect his skin every 8 hours along with the nursing staff. Learn to see the early signs, and insist that something be done if you see even any pinkness. Even a small pressure ulcer is preventable, and if he gets one, it will keep him from getting into a good rehab program (and is a strike against the hospital with Medicare).

    Neurologists don't know a lot about SCI, rehab, and long term outcomes. Insist that a physiatrist (physician specialist in rehabilitation) evaluate your dad, and get him referred to a specialty inpatient SCI rehabilitation program. He may need to go a ways from home from this, but that is critical. Don't let him go do a nursing home, "sub-acute" rehab (nursing home as well) program, or a general acute rehab program that does not see at least 30 new SCI patients each year for rehab. You will need to fight for him on this. We can help.

    (KLD)

  3. #3
    Thanks for your advice Nurse. My dad is on a pressure reducing mattress that is filled with air, although I do not know if this is low air loss or not. It does vibrate slightly about every 5 minutes or so. He is being turned every half hour and seems to receiving excellent care at the hospital. He has been referred to a specialist NTSCI rehab unit, although at this stage we are unsure when he will be transferred. I assume that will be once he is diagnosed, as he seems fairly medically stable. He is due to have another MRI tomorrow.

    We are Australian, so being a veteran would not entitle him better health care than he is receiving. Our health care system here is excellent and all of the above is being provided under our public health system to which all citizens are entitled.

    Again, thank you for your advice, I really do appreciate it.

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