What's next for my mother after stroke treatment?
My mother is s two time stroke survivor. Her latest one, in October, affected the thalamus, and caused left side hemianesthesia. She is recovering well, but had swelling in the left joints, of which all has resolved except for the left hand. the doctors say there is no clots, as she had a Doppler, and also took her off her amlodipine. Swelling still persists and I am worried about long term damage, possible atrophy, etc. What should I have the doctors focus on next?
Expert Answer
I have found that persistent swelling after a stroke is not uncommon. It has never been entirely clear to me what the cause is, but it is probably related to a loss of vascular tone in the effected arm and leg. The arm and leg begin to swell as fluid leaks out of the vessels, as the brain is no longer keeping the vessels as "tight" as they should be. This fluid buildup is more a nuisance than a dangerous medical issue. However, it is always worthwhile to check an ultrasound (to make sure there are no clots) and to remove possibly offending medications (Calcium Channel Blockers such as amlodipine being at the top of the list). Beyond that, elevating the limbs is often helpful to promote draining of the fluid. During sleep, or when sitting in a chair, have your mother prop her arm and leg up in an elevated position. This should prevent fluid from pooling. Also, tight fitting stockings (Jobst stockings - which can be found at most drug stores) are very helpful for preventing the pooling. Rehabilitation of the arm and leg by working with physical and occupational therapists is also very helpful - try to keep her as active as possible. Finally, in rare occasions, if the swelling is painful, a diuretic medicine can help reduce the fluid.
I hope that helps.