Bowel Incontinence Turned Out To Be The Key Clue In Diagnosing Stroke In A 68-Year-Old Man – A Detailed Medical Case Report

It is not often that bowel incontinence serves as the primary symptom leading to a stroke diagnosis. This case involves a 68-year-old male whose unexpected loss of bowel control ultimately revealed an underlying brain infarction. Below is a comprehensive overview of the patient's journey from initial symptoms to diagnosis and successful treatment.

Patient Overview

Patient: Male, 68 years oldDiagnosis: Bowel incontinence due to cerebral infarctionTreatment facility: Shandong Third Provincial HospitalTreatment period: November 2021Treatment plan: Medication therapy including Cerebrolysin tablets, Xueshuantong tablets, Butylphthalide soft capsules, Aspirin enteric-coated tablets, and Atorvastatin calcium tabletsRecovery timeline: 12 days of inpatient treatment followed by a one-month outpatient follow-up

Initial Presentation And Diagnosis

The patient visited the hospital independently, reporting a sudden onset of uncontrolled bowel movements without any obvious cause. Despite experiencing no other significant discomfort, the condition severely impacted his quality of life and caused emotional distress due to reactions from family members.

Initially, he consulted the colorectal surgery department, where tests ruled out any structural or organic damage to the anal sphincter. Following this, he was referred to neurology. Upon neurological examination, reduced anal sensation was noted. Considering his medical history of hypertension and diabetes, a possible stroke was suspected.

An MRI of the brain confirmed a lesion in the paracentral lobule, leading to a preliminary diagnosis of cerebral infarction with associated bowel incontinence. Hospital admission was recommended for further management.

Treatment Process And Recovery

Once admitted, the patient underwent further MRI imaging and vascular studies, which confirmed a recent infarction in the paracentral lobule along with cerebral atherosclerosis. Blood tests revealed elevated cholesterol and blood sugar levels, prompting aggressive management of these risk factors.

A targeted treatment plan was implemented focusing on improving cerebral circulation, supporting neuronal health, preventing platelet aggregation, and managing atherosclerosis. Medications included brain protein hydrolysate, vasodilators, antiplatelet agents, and statins.

Given the patient's fluctuating blood pressure, antihypertensive therapy was adjusted accordingly. After 12 days of treatment, the patient was discharged with noticeable improvement. During a follow-up visit two weeks later, bowel control had further improved. Complementary acupuncture therapy was recommended to enhance neural recovery, and regular neurology follow-ups were scheduled.

Clinical Insights And Outcome

Stroke is typically associated with motor deficits or speech impairments, but in this case, it manifested as bowel incontinence. Early diagnosis and prompt treatment played a crucial role in the positive outcome. Due to the small infarct size and timely intervention, recovery was relatively quick.

Acupuncture therapy was introduced during the recovery phase to stimulate nerve regeneration. One month after discharge, a follow-up phone call revealed stable blood pressure and glucose levels, with significant improvement in bowel control. The patient was advised to continue regular check-ups and maintain control over his risk factors.

Post-Treatment Recommendations

As the patient improved, he was counseled on lifestyle modifications crucial for long-term recovery. Dietary advice included a low-salt, low-fat regimen with increased intake of fruits and vegetables. Spicy, irritating, or cold foods were discouraged.

Establishing a regular bowel routine was emphasized to maintain gastrointestinal health. Skin care was also highlighted in case of recurring incontinence episodes. Lifestyle changes such as quitting smoking, avoiding overexertion, and managing stress were recommended. Family support was encouraged to prevent emotional strain from worsening symptoms.

Regular monitoring of blood pressure, glucose, cholesterol, and uric acid levels was advised. Any new symptoms such as motor deficits, speech difficulties, persistent diarrhea, or abdominal pain warranted immediate medical attention.

Clinical Perspective

Bowel incontinence can be a manifestation of various conditions, including chronic colitis, anal nerve injury, spinal cord disorders, encephalitis, or stroke. This case highlights the importance of a comprehensive diagnostic approach, including MRI scans of the brain and spine, along with anal sphincter evaluations.

Patients experiencing such symptoms should seek medical attention promptly to avoid misdiagnosis or inappropriate treatment. Preventive healthcare, including regular screenings and monitoring of risk factors, plays a vital role in early disease detection and management.