Hello

Thanks for the query

From the details given to me it looks to me like she is suffering from post stroke depression probably due to the disability caused by the hemiparesis and stroke. Though she is partially recovered, she is still dependent for her daily activities due to motor weakness (Right sided hemiparesis).

Depression is more common in strokes happening over the left side of the brain (causing right hemiparesis) in comparison to the right due to various reasons. Other contributing factors for depression in strokes are living alone, dependent on other for daily activities, stroke in younger age and lack of social support.

My recommendation for you is to see a psychiatrist and clinical psychologist for a good clinical evaluation and consultation. She requires antidepressants for control of depression and to avoid depression related complications in the future. It is recommended to treat depression in the early stages in stroke to avoid problems with neuro-rehabilitation. Making her more independent by physiotherapy, giving social support along with good counseling and psychotherapy would reduce the risk of further depression in the future.

I would also like you to discuss the options with the Neurologist for secondary stroke to avoid future stroke. If one has stroke and the risk factors of stroke are not identified and controlled, risk of second stroke is very high.

I thank you again for submitting your question. I hope you have found my response to be helpful.

If you have additional concerns I would be happy to discuss them with you.

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.

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Hello

Thanks for the follow up query

As you already mentioned it to me that her stroke was related to high blood pressure, good control of BP would be first priority in her along with treatment of depression.

Regarding the question on permanent solution and recovery, recovery is usually not complete in most cases due to permanent brain damage sustained due to the blood clots. With good physiotherapy recovery is possible only to the extent of 70-80%. As it is already 21/2 years post stroke I would say the chances of her recovery may be to the extent of 5-10% and not more than that.

You need to talk to the occupational therapist to see how we can make her more functional using her deficits. If stiffness is a problem which is causing pain and movement restriction on the right side of the body we can think of Botox injections to reduce the spasticity and re-start physiotherapy.

So I feel we don't have any permanent solutions for her problem and we can only think of ways to minimize the existing problems.

Wishing her good health.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.

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