Vahin Mohanakrishnan, MBBS
International Medical Graduate
Government Sivagangai Medical College
Coimbatore,, Tamil Nadu, India
Priyavadhana Radhakrishnan, MD, DNB (PMR), DPMR
Head of Department
Institute of Physical Medicine and Rehabilitation, Royal Care Super Speciality Hospital
Coimbatore, Tamil Nadu, India
Young Stroke/ Left MCA territory infarct with mass effect.
This study reports on a 31-year-old male with history of left MCA territory infarct with mass effect. Patient underwent emergency left decompressive hemicraniectomy, followed by bone flap implantation 5 weeks later. Patient was referred to our facility, presenting with right hemiplegia, aphasia and blurred vision in the left eye, and was admitted for rehabilitation services. Ophthalmic examination revealed that only perception of light was preserved in the left eye, with associated optic atrophy. The patient received the usual rehabilitation services, along with five sessions of Repetitive Transcranial Magnetic Stimulation using a coupled protocol targeting the visual cortex (high-frequency stimulation on the left and low-frequency stimulation on the right).
rTMS was well tolerated by the patient, and no adverse effects were observed. Visual acuity in the left eye improved to 4/60, and the patient was able to read the baseplate of the Ishihara test.
rTMS is a promising neuromodulation technology that is being used in stroke rehabilitation. Its ability to enhance neuroplasticity makes it a potential treatment option for improving deficits associated with stroke when combined with traditional rehabilitation services. However, more research is required to determine the optimal stimulation sites, parameters, and protocols for using rTMS as a treatment modality.
