What are the chances that my wife will recover her speech after her stroke?

Zanne1 asked...

My wife Suzanne 61 years old, had her first major brain haemorrhage involving the right temporal and parietal lobes in March 2010 and after 5 weeks in hospital, after an urgent craniotomy to remove the blood, she went to the rehab unit where after another 5 weeks I took her home. An angiogram was done when she was at the rehab hospital which indicated that all the veins in her brain were normal. The professor diagnosed Amyoloid Angiopathy.

She had the use of her speech, could eat by herself and the use of her right arm and leg. Her spatio visual improved well and she was even starting to do cross word puzzles As the next few months progressed, Suzanne got better with neuro physio and occupational therapy and was getting to the point, where she started to take a few assisted steps and she was hugely positive that she would walk unaided within a few months.

Unfortunately, she had another massive brain haemorrhage in the same area of the brain on the 23 September 2010 and went through the normal trauma of this insult to the brain, surgical intensive care unit with ventilator, venticular drain etc. After 4 weeks, she was admitted to the general ward but this time, she has no movement in ANY of her limbs and is unable to speak. She is able to move her head only. We started neuro physio and occup therapy and speech therapy already by the second week. After 2 months Suzanne had another haemorrhage which was unknown to us and was picked up on an MRI which was done to try to understand why her right side and speech was affected when the MRI indicated that the structure of the left brain was intact but a right frontal haematoma had developed.

What was interesting is that with the previous bleeds, if Suzanne had not been admitted to hospital immediately, she would have died of the brain bleed yet we were unaware of this frontal lobe bleed. There was no indiction of this last bleed in any of her vital signs. Remember, she could not speak and tell us anything.

She has now been admitted to a care facility from 1 December 2010 because she requires 24 hour nursing. She still has neuro physio daily and occupational and speech therapy 2 to 3 times a week. Suzanne is in a wheelchair twice a day and is taken for a 1 to 2 hour walk in the care centre to stimulate her brain, see the gardens and experience the fresh air. Suzanne has a complete understanding of what we are saying to her and she vocalises this through a crying response which really is traumatic for the family. Remeber, she also experiences emotions and has emotional lobility as a result of the frontal lobe bleed.

We needed to remove the NG tube and get a PEG inserted to make her feeding more practical and when she went back to hospital for the small procedure, we had a CAT scan done of the brain just to ensure that the injuries were healing. The report dated 28/12/2010 reads as follows:

" extensive old infarcts/ evacuated haemorrhages involves the right temporal and parietal lobes associated with focal atrophy. No recent bleed. Old infarcts are also noted in the right frontal lobe inferiorly and left frontal lobe superiorly. Compensatory dilation of the right lateral ventricular system is present. Previous craniotomies noted"

My question to this long background particularly over the last 4 months since the September bleed, is what is the chance of Suzanne being able to recover her speech and being able to move her right side again. Remember, the MRI scan indicates that the left brian is structurally sound and the speech area is clear. Also there is no stroke indicated on the brain stem.

We wait every day for the small steps we have been told to expect but my question is has anyone experienced this type of event and what has the prognosis been? I know that each person is different but there are so many recovery stories which take place over the first 12 months and seem to continue afterwards and this has to be my hope and continue to pray for God's help. She understands what has happenned to her and I cannot imagine what she must be experiencing in trying to tell us what she feels or whatever and this is just not possible to comprehend.

Any comments please.

Expert Answer

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

I am truly sorry to hear of these chain of events. I have a few thoughts:

First, given the number of hemorrhages that have occurred, I would make sure that the treating physicians are absolutely certain that the diagnosis is amyloid angiopathy. As the strokes were on the same side of the brain on several occasions, I would want the reassurance of either a Neurosurgeon or a Stroke specialist that further testing does not need to be done to completely rule out an abnormal blood vessel. If amyloid angiopathy is the cause, the best treatment is to very tightly control her blood pressure and avoid giving any blood thinners. Unfortunately, the long term prognosis of amyloid angiopathy is fairly grim as there is no cure for this disease.

Second, recovery after several strokes is hard to predict. In general, the best therapy is to 1) try and maintain a positive outlook for possible recovery, 2) get her up an out of bed, working with therapy, etc. as much as possible, 3) treat any confounding depression (extremely common after several strokes) with an anti-depressant and a healthy dose of a positive attitude.

For the most part, at this point, suffice to say that she seems to have suffered some very devastating brain injuries, and that love, support, and optimizing medical and rehabilitative care is the best therapy she can get.

I wish you good luck with her recovery.