Q. My wife finds it hard to walk after a stroke some months back. Will she get better?
Hi doctor,
My wife has diabetes and hypertension. She suffered a CVA (left basal ganglia ICH) with right hemiparesis some months back. She is on Insulin (Novorapid and Lantus), Galvus Met 50 mg/500 mg (last 20 years), Telma 40 mg, Liofen, Statin 10 mg, and Felicita. Of late, she feels difficulty in walking. No strength in her lower extremity. She has pain in the legs. I am her husband, and I am 72 years old. I have no medical history. We have three sons, and all are married. The eldest son is 50 years old. He is diabetic and hypertensive and has urine issues. The second son is 47 years old and has thyroid issues. The third son is 42 years old and has sinusitis. I am awaiting a reply.
Hi,
Welcome to icliniq.com.
Please tell me a few details. After ICH (intracerebral hemorrhage), did her power in the right leg improve to some extent in the last three months? Is it the same, or has it got worsened? In which portion is she having pain? And since when is that pain?
Please give the following required information,
- After ICH, did her power in the right leg improve to some extent or worsened, or is it the same?
- Did she start to walk after ICH?
- Are the symptoms improving at a slow pace or worsened?
- As you mentioned, "of late she feels difficulty walking," I would like to know since when is she having difficulty in walking? And what exact problem she feels? Weakness or pain or tiredness or imbalance while standing or walking?
- In which leg she has pain? And what kind of pain stretching or tingling or pins and needles sensations or heaviness or currents like sensation or crawling sensations or burning?
- How is her day-to-day mood? Happy or sad?
- How is her sleep nowadays?
- How is her sugar level? Does she check blood sugar at home with a glucometer? If yes, what are her normal blood sugar levels in fasting and after-meal in recent days?
Please revert with details for better understanding, and also, please send the previous reports along with prescriptions and discharge summary and, if possible, CT (computed tomography) images as an attachment.
Hi doctor,
Thanks for the reply.
She feels pain while walking. Imbalance while standing and walking. She is always worried about her future due to diseases. There is no perceptible improvement since the stroke; rather, it has worsened. Pain and weakness (heaviness) is more in the right leg. Sugar level is under control (fasting 85 mg/dL to 110 mg/dL and after meal 150 mg/dL to 160 mg/dL).
Hi,
Welcome back to icliniq.com.
1. What kind of pain does she feel in her right leg? Stretching, tingling, pins and needles sensations, heaviness, current-like sensation, crawling sensations, or burning?
2. Exactly in which portion of the right leg she feels pain? Hip, front thigh area, thigh backside, knee, calf region, ankle, or foot?
2. Since how many days, the pain in the legs started?
3. Does she have back pain also?
4. As you mentioned, the weakness in her right leg has increased. I would like to know for how many days the weakness has increased?
How much could she lift her right leg in the air at the time of ICH (while lying straight on the bed)? How much can she raise her right leg in the air nowadays (while lying straight on the bed)? Forgoing to toilets, can she go by herself? Does she use a stick? Does she need the support of one or two persons? How are her blood pressure recordings at home (nowadays, while taking regularly prescribed medicines)? Is she receiving physiotherapy daily? Please ask these things from her and revert. Thanks.
Hi doctor,
Thanks for the reply.
She is getting physiotherapy.
Hi,
Welcome back to icliniq.com.
Please give information for all the points asked above. Is she getting physiotherapy? Or psychotherapy?
Hi doctor,
Thanks for the reply.
She has shortness of breath. Her vocals are not audible. Her speech is feeble. Please help.
Hi,
Welcome back to icliniq.com.
1. What kind of pain does she feel in her right leg? Is it stretching, tingling, pins and needles sensations, heaviness, current-like sensation, crawling sensations, burning, or something else?
2. Exactly in which portion of her right leg does she feel the pain? Hip, front or back thigh region, knee, calf region, ankle, or foot?
3. When did her pain in the legs start?
4. Does she have back pain also?
5. When did the weakness increase? How much could she lift her right leg in the air at the time of ICH (while lying straight in the bed ) and now?
6.Does she go to the restroom by herself, or does she needs the help of a stick or anyone?
5. How are her blood pressure recordings at home (now while taking regularly prescribed medicines)?
6. From when is she breathless? Is it in a lying position or while walking?
Please ask these things from the patient and revert for each information point-wise.
Hi doctor,
Thanks for the reply.
I have attached some reports for your reference. Please comment.
Hi,
Welcome back to icliniq.com.
I saw the pictures (attachments removed to protect the patient's identity). She is able to stand and walk with the help of a stick. But I have no clear description of her symptoms. I would like to know following information.
1. What kind of pain does she feel in her right leg? Is it stretching, tingling, pins and needles sensations, heaviness, current-like sensation, crawling sensations, burning, or something else?
2. Exactly in which portion of her right leg does she feel the pain? Hip, front or back thigh region, knee, calf region, ankle, or foot?
3. When did her pain in the legs start?
4. Does she have back pain also?
5. When did the weakness increase? How much could she lift her right leg in the air at the time of ICH (while lying straight in the bed ) and now?
6.Does she go to the restroom by herself, or does she needs the help of a stick or anyone?
5. How are her blood pressure recordings at home (now while taking regularly prescribed medicines)?
6. From when is she breathless? Is it in a lying position or while walking?
Please ask these things from the patient and revert for each information point-wise.
You can also consult a neurologist.
Hi doctor,
Thanks for the reply.
Can you please suggest some way to help her?
Hi,
Welcome back to icliniq.com.
Please give the information that I have asked previously for a better understanding. Moreover, in many situations, it is difficult to make a judgment with limited information. Thanks.
Hi doctor,
Thanks for the reply.
She has pain and heaviness while walking and getting up from the chair or bed. She has pain in the groin, the backside of the thigh, swelling, pain in her knee, calf, back. Her blood pressure is normal. She is taking Telma 40 mg. She has shortness of breath (not breathlessness while lying) due to short breath; she cannot read long sentences—this problem she has been having for the last five or six years. Please help.
Hi,
Welcome back to icliniq.com.
As per your information, possibilities (differential diagnosis) may be,
1. Spasticity in her right leg (after stroke).
2. Deep vein thrombosis in her right leg.
3. Radicular pain in her right leg.
4. Diabetic neuropathy.
Following investigation might help make a conclusion,
1. USG (ultrasonography) venous doppler of bilateral lower limbs.
2. MRI (magnetic resonance imaging) of the lumbosacral spine with a full spine screening.
3. NCV (nerve conduction velocity) of bilateral lower limbs.
4. Serum vitamin B12 levels.
For the time being (till a conclusion is made), she can try the following medicine,
1. Tablet Gabapin 100 mg (Gabapentin) thrice daily for seven days.
Through limited sources, it is not feasible to come to one conclusion. In such a scenario, I suggest you consult a neurologist physically and also may require investigations.
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