Overcoming Post-Stroke Hemiplegia: How Timely Treatment and Rehabilitation Restored Mobility in an Elderly Patient

Medical Disclaimer: This article is intended for educational and informational purposes only. To protect patient privacy, all personal and medical details have been anonymized and appropriately modified.

Case Summary: A 70-Year-Old Woman Recovering from Ischemic Stroke

A 70-year-old female presented with recurrent episodes of unilateral limb weakness that initially resolved within 15 minutes. Her family dismissed the symptoms as age-related. However, when persistent motor deficits occurred three days prior to admission, she was promptly brought to the hospital. Brain MRI confirmed acute ischemic stroke. With timely pharmacological intervention and early rehabilitation, the patient showed significant improvement in muscle strength and functional mobility during her 12-day hospitalization. Follow-up one month later revealed continued progress, highlighting the importance of early diagnosis and comprehensive post-stroke care.

Patient Profile at a Glance

Gender: FemaleAge: 70 yearsDiagnosis: Acute ischemic stroke with secondary hemiplegiaHospital: Shandong Provincial Third HospitalDate of Admission: February 2021Treatment Plan: Dual approach combining medication (antiplatelet agents, statins, neuroprotective infusions) and structured physical rehabilitationTreatment Duration: 12 days inpatient care, followed by outpatient monitoring and therapyOutcome: Stabilized condition, improved limb function, and increased independence in daily activities

Initial Clinical Assessment: Recognizing the Warning Signs

On the second day of the Lunar New Year, the patient arrived at the emergency department accompanied by her family. They reported that over the past week, she had experienced transient episodes of left-sided weakness—each resolving spontaneously after about 15 minutes. These were initially mistaken for fatigue or normal aging. However, when the weakness persisted for more than 72 hours, concern grew, prompting immediate medical evaluation.

Neurological examination revealed a muscle strength grade of 2/5 in the right upper and lower extremities, along with positive Babinski signs—indicative of upper motor neuron damage. The preliminary diagnosis was acute cerebrovascular accident with resulting hemiparesis. Given the urgency, hospitalization was recommended to confirm the diagnosis through advanced imaging and initiate prompt treatment.

Diagnostic Workup and Therapeutic Strategy

Upon admission, a full panel of laboratory tests was conducted, including complete blood count, liver and kidney function, electrolytes, lipid profile, fasting glucose, HbA1c, and cardiac enzymes. Results showed elevated cholesterol, impaired glucose metabolism, and hyperuricemia—key risk factors for vascular disease.

Imaging Findings: MRI of the brain detected an acute infarct in the territory supplied by the middle cerebral artery, consistent with ischemic stroke. Additional findings included diffuse cerebral arteriosclerosis. Electrocardiogram and chest X-ray showed no major abnormalities.

Pharmacological Intervention

The treatment plan focused on stabilizing the patient's condition and preventing further neurological damage. Medications included:

• Aspirin enteric-coated tablets: For antiplatelet therapy to reduce clot formation
• Atorvastatin calcium tablets: To lower LDL cholesterol and stabilize atherosclerotic plaques
• Ginkgo biloba extract injection: To enhance cerebral microcirculation
• Edaravone injection: A potent antioxidant that protects neurons from oxidative stress
• Monosialotetrahexosylganglioside sodium injection: To support neural repair and regeneration

Rehabilitation Protocol

Due to delayed presentation, irreversible brain injury had already occurred. Therefore, the focus shifted to conservative management and maximizing functional recovery. A multidisciplinary rehabilitation team designed a phased program:

• Acute phase (in-hospital): Passive range-of-motion exercises for affected limbs to prevent contractures and maintain joint flexibility
• Post-discharge phase: Active resistance training, balance exercises, and gait re-education under professional supervision

The patient remained hospitalized for 12 days, during which time her condition stabilized and early signs of motor recovery emerged.

Observed Treatment Outcomes and Progress

Within three days of starting treatment, neurological status stabilized. Muscle strength improved from grade 2 to approximately grade 3. At discharge, motor function reached grade 3+, indicating active movement against gravity but not full resistance.

One month after discharge, the patient returned for follow-up. She reported complete resolution of numbness and noticeable improvement in limb control. With consistent home-based exercises guided by therapists, she regained partial independence in basic self-care tasks such as dressing and walking short distances.

Clinical Insight: The first six months following a stroke are widely recognized as the golden period for neuroplasticity and functional recovery. Encouraging patients and families to commit to long-term rehabilitation significantly enhances outcomes. Both the patient and her caregivers expressed strong motivation to continue therapy—an essential predictor of lasting success.

Key Recommendations for Stroke Recovery and Prevention

While this case ended on a positive note, ongoing vigilance is crucial. Here are critical guidelines for post-stroke management:

Lifestyle Modifications

Adopt a heart-healthy lifestyle to reduce recurrence risk:

• Maintain a low-sodium, low-fat diet rich in vegetables, whole grains, and lean proteins
• Avoid high-purine foods (e.g., organ meats, shellfish) to manage uric acid levels
• Eliminate alcohol and tobacco use, both of which accelerate vascular damage
• Ensure adequate sleep and avoid excessive physical or emotional stress

Medical Monitoring

Regular check-ups every four to six weeks are advised to monitor:

• Blood pressure
• Glucose levels (especially HbA1c for diabetic patients)
• Lipid profiles

If values remain uncontrolled, medication adjustments should be made promptly under physician guidance.

Red Flags Requiring Immediate Medical Attention

Patients and caregivers must watch for warning signs of worsening neurological status, including:

• Sudden decline in limb strength
• Slurred speech or difficulty understanding language
• Increased sensory disturbances (numbness, tingling)
• Dizziness, vision changes, or imbalance

Any of these symptoms warrant urgent re-evaluation to rule out recurrent stroke or complications.

Clinical Reflections: The Importance of Early Detection and Public Awareness

Hemiplegia following stroke results from disrupted neural pathways due to brain tissue ischemia. Common underlying contributors include chronic hypertension, atherosclerosis, diabetes, atrial fibrillation, and dyslipidemia—all modifiable risk factors.

This case underscores a vital lesson: transient neurological symptoms like brief limb weakness may represent transient ischemic attacks (TIAs), often precursors to full-blown strokes. Had this patient sought care earlier during her initial episodes, interventions such as thrombolysis or endovascular therapy might have been possible, potentially preventing permanent disability.

Call to Action: Healthcare providers must prioritize patient education. When evaluating individuals with multiple cardiovascular risks, clinicians should emphasize the significance of symptom recognition and preventive strategies. Community outreach, public health campaigns, and routine screening can play transformative roles in reducing stroke incidence and improving long-term outcomes.

In conclusion, while stroke can lead to debilitating consequences, a proactive combination of evidence-based medicine and dedicated rehabilitation offers real hope for recovery—even in older adults. Early action saves brain cells, and sustained effort restores quality of life.