Aliza M. Perez, DO
Resident Physician
The Mount Sinai Hospital- NYC
new york city, New York, United States
Yehuda Azerrad, MS
Medical student
NYIT school of medicine
new york city, New York, United States
Avniel Shetreat-Klein, MD, PhD, MD, PhD
Attending Physician
The Mount Sinai Hospital- NYC
new york city, New York, United States
A 38-year-old male with hypertension, type 2 diabetes, and a history of transient ischemic attack presented to acute rehabilitation with right-sided hemiparesis and dizziness. Imaging revealed left vertebral artery thrombosis and left lateral medullary infarct. His hospital course was complicated by cardiac arrest, aspiration pneumonia, duodenal ulcers, and multiple deep vein thrombosis. Genetic workup revealed a homozygous prothrombin gene mutation, indicating an inherited thrombophilia. Neurological examination on admission to rehabilitation showed intact cognition but 0/5 strength in the right upper and lower extremities, dysphagia, and dysarthria. He required maximal assistance with daily functions. During rehabilitation, he progressed to minimal-to-moderate assistance in some activities with some return of strength in his right upper extremity. However, his home situation posed significant challenges, including caring for seven children, one of whom has special needs. Discharge planning included his mother’s involvement and extensive family training.
Discussions:
This patient’s prothrombin mutation contributed to a stroke at an age when he had significant family and financial responsibilities. The residual physical deficits of his stroke compounded the demands on a household with already substantial caregiving needs, and relying solely on his wife for support seemed inadequate given their seven children. A multidisciplinary approach involving social work, support services, genetic counseling, and extended family was necessary to address his medical needs and the complex dynamics of his family situation.
Conclusions:
This case underscores the importance of a holistic, patient-centered care plan in ensuring effective patient support and addressing the intricate needs of the family.
