Thanks to you and Raquel for a fabulous 2 day course. I truly enjoyed it and I am geared up to make a difference with many of my ABI patients. I am actually in the process of finalizing a chart from last week that I wanted to ask you a quick question about. This is a 64 year old women who suffered a stroke while having a surgical procedure for an aneurysm. The following is noted from her surgeon:
“64 year old woman who I have treated for a right parapontine arteriovenous malformation. She had a prenidal aneurysm from one of the feeding vessels to her AVM that I embolized with onyx. She had an aneurysm that was pressing on the facial nerve and vestibular cochlear nerve on that right side. This manifested as tinnitus and facial weakness. At the time the intention behind the embolization was to decrease the pulsation from the aneurysm on the nerve complex. Unfortunately, this led to a brain stem and cerebellar peduncle stroke”. She still has difficulty with gait and right arm dysmetria. She still has difficulty with vertigo, particularly when turning her head. Her current PT has felt that she has maximized her vestibular rehab with them and they have recommended rehab in Raleigh”.
The year prior to the surgery she lost vision in her OS and was diagnosed with NAION. Her VA in that OS is 20/100. Her VA in her good right eye is 20/20. She was not having any ambulation issues after she lost her vision from the NAION. It was only after the stroke that she began to have a difficult time with her ADL’s. Her main issues are balance and dizziness issues. She has been through vestibular therapy and as stated above the therapist felt she had reached her maximum benefit. I did do a VMS test and did not detect a VMSS with the testing. In watching her ambulate she takes very short steps and walks extremely fast. Her husband said she has always walked quickly. I did not note a postural shift last week but perhaps after refining my skills this past weekend I may pick up on something that I missed.I have tried a spot patch to reduce her complaints of central blur OS and also tried binasal occlusion which appeared to make her more unstable. I did not do a VEP b/c of her poor vision OS. My questions are:
Would you do a VEP on this patient being that her VA is reduced OS (she still has vision?) ?
Based off of the brief history that I have given you, would you agree with me that I need to get her back into the office, video tape her ambulating, and consider initiating neuro-visual postural therapy?
Thanks again for all you do and sharing your experience, knowledge and wisdom with us.