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Rehabilitation Practice and Science

Translated Title

抗磷脂抗體症病患併發慢性硬腦膜下出血：病例報告

Abstract

Patients who suffer antiphosphlipid antibody syndrome may have two kinds of antibodies, Anticardiolipin and Lupus anticoagulant. These antibodies may increase the risk of ischemic stroke and cerebral ischemia. However, the incidence of cerebral bleeding is relative rare. As a result, patients with antiphosphlipid syndrome often take oral anticoagulants for a long-term period to prevent ischemic stroke attack.We report a female patient who was diagnosed antiphosphlipid antibody syndrome in 1998, and took oral anticoagulants for a long period to restrain the symptom of thrombosis. The INR(International Normalized Ratio)value has been kept between 1.5 to 2.0 by controlling the dosage of oral anticoagulants in the past years. However, she still suffered ischemic stroke several times during these years despite of using preventive oral anticoagulants. Left hemiparesis and motor aphasia occurred of repeated ischemic strokes, she could only communicate in a simple way and perform activity of daily activities with minimal assistance although she had received a long-term rehabilitation program. In the last ischemic stroke episode, she was admitted to the medical wards and received an adjustment of the dosage of oral anticoagulants to keep the INR range between 3.0 to 4.0 to efficiently avoid ischemic stroke. After being medically stable, she was transferred to our rehabilitation wards for further management of impaired cognitive function and mobility. After receiving rehabilitation programs, the patient had some impairment, and was still unable to be independent. Therefore she was transferred to a nursing home. Unfortunately, seizure attacked after discharge, and she was readmitted for treatment. Due to chronic subdural hemorrhage, a complication of oral anticoagulants, occurred. Antiplatelet agents replaced oral anticoagulants for the prevention of repeated ischemic stroke. No more new neurological symptoms happened after using antiplatelet agents. During the hospitalization, she received rehabilitation programs for improving her functional status and communication ability. But severe neurological deficits still cause her to lose almost all the abilities of daily living. The rehabilitation plans focused on long-term care and the prevention of falling. This article investigates the pathophysiology mechanism of repeated stroke and other complications caused by antiphospholipid antibody syndrome. On the other hand, we discuss the possible reasons of subdural hemorrhage in this case and some related bibliography.

Language

Traditional Chinese

First Page

111

Last Page

116

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