Is it common or expected for a person (58 yo) to continue to...

Michiganfran asked...

Is it common or expected for a person (58 yo) to continue to deteriorate post-stroke? M had a severe total right middle cerebral artery clot stroke two years ago. In the last few months, her right side has become affected (tight muscles, less movement, she is less alert (she does not talk), she often sleeps in a decorticate position. I am devastated, as I was hoping for some recovery so that I could bring her home.

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Continued deterioration after a stroke is not common, and it sounds like she needs further evaluation.

There are situations where a patient can become more stiff as time goes by, as the spinal cord takes over the function that the brain used to provide, and causes tightening of the muscles of the affected limbs. However, a deterioration in mental status is not normal, and makes me think something else is going on.

I would recommend an evaluation - with repeat imaging of the brain (preferably with MRI), blood checks (specifically evaluating for thyroid level, vitamin B12 level, and signs of infection), and possibly an electroencephalogram to look for signs of subtle seizures that can develop after a stroke. An additional thought is that she is suffering from severe depression and has not been exercising or moving the muscles enough.

The bottom line here is that deterioration this far after a stroke would not be expected, and should be evaluated by a Neurologist.