Elderly Patient Recovers Motor Function After Sudden Onset of Hemiparesis Due to Acute Cerebral Infarction

Medical case studies play a vital role in understanding the progression and treatment of neurological conditions. This article explores the journey of a 64-year-old male patient who experienced sudden left-sided limb weakness, later diagnosed as hemiparesis caused by an acute cerebral infarction near the lateral ventricle. With timely hospitalization and a comprehensive pharmacological approach, the patient showed significant improvement in motor function and overall stability. While names and personal details have been altered for privacy, this real-world scenario highlights the importance of early diagnosis, appropriate intervention, and long-term management strategies for stroke-related complications.

Patient Overview

Age & Gender: 64-year-old maleDiagnosis: Hemiparesis, acute-phase cerebral infarction adjacent to the lateral ventricle, cerebral arterial stenosisHospital: Second Affiliated Hospital of Harbin Medical UniversityDate of Admission: February 2022Treatment Plan: Multimodal drug therapy including Sulxuetong injection, Erigeron breviscapus injection, Batroxobin injection, Cerebroprotein hydrolysate oral solution, Atorvastatin calcium tablets, and Valsartan tabletsTreatment Duration: 8-day inpatient care followed by scheduled outpatient follow-upsOutcome: Noticeable reduction in limb weakness, stabilized condition, improved mobility with assistance

Initial Assessment and Diagnosis

The patient, referred to as Mr. Zhang, arrived at the emergency department seven hours after experiencing unexplained weakness in his left extremities. He was unable to lift his left arm or walk independently. Notably, there were no accompanying symptoms such as slurred speech, hearing issues, dizziness, loss of consciousness, or seizures—common red flags in stroke cases. Given his history of hypertension (though poorly managed due to irregular medication use) and smoking, cerebrovascular pathology was strongly suspected.

An urgent non-contrast CT scan of the head revealed bilateral lacunar infarcts but failed to identify a definitive causative lesion. After clinical evaluation and discussion with the family, acute ischemic stroke was diagnosed. Unfortunately, because more than six hours had passed since symptom onset—the critical window for thrombolytic therapy—the option for clot-dissolving drugs like tPA was no longer viable. The family expressed disappointment but quickly agreed to hospital admission for alternative treatments aimed at halting disease progression and supporting recovery.

Neurological Examination Findings

Upon admission, Mr. Zhang was alert and oriented, with fluent speech and stable vital signs: temperature 36.2°C, blood pressure 160/90 mmHg, heart rate 76 bpm, respiratory rate 16 breaths/min. Neurological testing indicated grade 4 muscle strength in the affected left limbs—a clear sign of moderate impairment. Further imaging was essential to confirm the extent and location of brain damage.

Advanced Imaging Confirms Stroke Location

A brain MRI was performed, which provided high-resolution visualization of cerebral structures. The results confirmed an acute ischemic lesion in the periventricular region on the right side—specifically near the right lateral ventricle—consistent with recent infarction. Additionally, evidence of cerebral artery stenosis was observed, indicating underlying atherosclerotic vascular disease that likely contributed to the event.

This finding explained the unilateral motor deficit: the right hemisphere controls the left side of the body, so damage in that area directly impacted left-arm and leg function. The diagnosis was finalized as acute cerebral infarction secondary to small vessel disease and arterial narrowing, leading to partial paralysis (hemiparesis).

Comprehensive Treatment Strategy

By the second day of hospitalization, Mr. Zhang's condition worsened—his left limb strength declined from grade 4 to grade 2, alarming both him and his family. This temporary deterioration is not uncommon during the early phase of ischemic stroke, often due to ongoing edema or extension of the ischemic penumbra.

To address this, we initiated a multi-targeted pharmacological regimen designed to improve cerebral perfusion, reduce clot burden, protect neural tissue, and manage risk factors:

• Batroxobin Injection: Used to degrade fibrinogen and reduce blood viscosity, thereby improving microcirculation. While effective, it carries a risk of hemorrhagic transformation, which was thoroughly discussed with the family before consent.
• Sulxuetong and Erigeron breviscapus Injections: Both are known for enhancing cerebral circulation and reducing platelet aggregation, commonly used in integrative neurology protocols in certain regions.
• Cerebroprotein Hydrolysate Oral Solution: Supports neuronal metabolism and may aid in neuroplasticity and functional recovery.
• Atorvastatin Calcium: A potent statin prescribed to lower LDL cholesterol and stabilize atherosclerotic plaques, reducing future stroke risk.
• Valsartan: An angiotensin II receptor blocker (ARB) used to control hypertension and provide additional vascular protection.

Daily Monitoring and Supportive Care

Throughout the 8-day hospital stay, Mr. Zhang received daily neurological assessments. As his physician, I made it a priority to communicate transparently about his fluctuating symptoms, explaining why some worsening could occur before improvement. This helped build trust and encouraged adherence to bed rest, hydration, and medication schedules. Over time, his condition plateaued and then began to improve.

Recovery Progress and Discharge Outcome

After one week of intensive treatment, Mr. Zhang demonstrated measurable progress. Although he still couldn't raise his left arm voluntarily, he regained enough lower-limb strength to walk short distances with physical support. Importantly, his condition stopped deteriorating, marking the end of the acute phase.

He met discharge criteria with stable vitals, improved cooperation, and reduced dependency. Before being released, he and his family were counseled on post-stroke rehabilitation, lifestyle modifications, and medication compliance. Follow-up was scheduled for four weeks later to assess continued recovery and adjust treatment if needed.

At the one-month follow-up visit, Mr. Zhang reported steady improvement. He could now stand and walk independently around the house, a significant milestone. Both he and his family expressed high satisfaction with the outcome, crediting the medical team's consistent care and clear communication.

Post-Discharge Recommendations for Long-Term Recovery

While the immediate crisis had passed, long-term success depends heavily on proactive self-management. Key recommendations included:

Physical Rehabilitation Guidance

Due to persistent left-sided weakness affecting both upper and lower limbs, targeted exercises were advised. For the arm, gentle stretching and passive range-of-motion activities were recommended to prevent contractures. Leg exercises focused on flexion and strengthening under supervision. Limbs should be kept in functional positions when resting to avoid deformities. Bed rest remains primary, with bathroom trips only permitted under family supervision to prevent falls and fractures.

Nutritional and Lifestyle Modifications

Diet plays a crucial role in secondary stroke prevention. Patients are encouraged to eat balanced meals rich in lean proteins such as fish, chicken, and grass-fed beef. Portion control is emphasized—overeating increases cardiac load and metabolic stress. Alcohol consumption must be limited, especially hard liquor, as excessive intake accelerates cerebral atherosclerosis and disrupts vascular autoregulation. Smoking cessation was strongly urged, given its well-documented role in endothelial dysfunction and stroke recurrence.

Clinical Reflections and Psychological Considerations

This case underscores several key points in stroke management: first, time is brain—delays in seeking care can eliminate life-saving interventions like thrombolysis. Second, even without clot-busting drugs, aggressive supportive therapy can alter outcomes significantly. Third, recovery is rarely linear; patients may experience setbacks before stabilization, requiring empathy and continuous education.

Equally important is recognizing the psychological toll of stroke. Mr. Zhang endured emotional highs and lows—from initial panic to frustration during symptom worsening, then cautious hope as recovery began. Post-stroke depression affects up to one-third of survivors and can hinder rehabilitation. Therefore, integrating mental health screening into routine follow-ups is essential. If signs of anxiety or depression emerge, early referral to counseling or psychiatric services can make a meaningful difference.

Final Thoughts on Stroke Prevention and Awareness

Mr. Zhang's story serves as a powerful reminder of the silent dangers posed by uncontrolled hypertension, diabetes, and smoking. These modifiable risk factors collectively create a perfect storm for cerebrovascular events. Public awareness campaigns, regular health screenings, and accessible preventive care are critical in reducing stroke incidence.

For healthcare providers, this case reinforces the value of multidisciplinary care—combining neurology, nursing, pharmacy, and psychology—to optimize patient outcomes. With proper intervention and sustained effort, many stroke survivors can regain independence and enjoy a good quality of life.