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Ariel

Cerebellar Stroke: questions and support needed

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My Partner had a cerebellar stroke on 8/28/17. She is currently in a nursing home for rehab. I am concerned because she can barely stay awake. She doesn't want to do anything but sleep. Is this normal? I'm asking because her CT scan showed no brain bleed, and her MRI without contrast did not show evidence of stroke even though the neurologist said he's sure that she's had a cerebellar stroke. She didn't make it through the CT scan with contrast, and refused a spinal tap. (She is super stubborn) When they transferred her to rehab, they did it with a diagnosis of ataxia.  They weren't able to say stroke, because they weren't able to verify evidence.

 

As a result, the nursing home really didn't know what was wrong with her. I had to inform everyone what had happened, and that the Dr. suspected stroke so the therapists would know how to deal with her case. She has very slurred speech and complains of dizziness and nausea all the time. She has been having  a hard time keeping food and drink down, vomiting pretty  much daily. She cannot sit up without nausea, and cannot stand or walk because she has no balance. I had them flush her ears, and they hydrated her with IV fluids, both which I hoped would help, but they didn't make much difference. Spoke with the Dr. on Monday about her dizziness, and he prescribed meclizine to help with that, but of course, she vomited it up as soon as they gave it to her. 
 

Does the dizziness wear off? Does the  nausea? Does the constant sleeping?  So frustrated.

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Welcome to the Stroke Network family but I'm sorry to welcome you to our family. Stroke or Brain trauma is never something that we can put a date or time limit on. I found this website and it was EXACTLY how I felt and it felt amazing to know I'm not crazy. http://vestibular.org/understanding-vestibular-disorder/symptoms 

 I went to all over to find answers and I was told basically that when it comes to the cerebellum, there is no answer. It sounds terrible but it is what it is.  I am dizzy all the time but as time went on I'm still dizzy but am able to manage it better.  I went from feeling like you were spun on a tire swing for hours to now.. I'm drunk. It varies depending on the weather. I feel like a barometer sometimes. Something else to keep an eye on. It didn't show up at first and it may not on her but in time I developed Nystagmus or bouncing eyes. It made my dizziness go bonkers but like with everything, it is manageable over time. I'm not saying life does get better,, for her it may do something different. She is still early on her recovery and can't definitively say this is how it's going to be. It's amazing how the body compensates for what isn't working right.  Keep the faith and positive thoughts..

 She's got this and so do you.

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Fatigue and sleeping lots are pretty common with brain injury too.  There's no harm in letting her sleep lots particularly early on, although I would think awake time will also be necessary if the brain is going to adjust or compensate to the dizziness and new sensations.

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Fatigue seems to happen to everyone post-stroke. Dizziness, while not as common, is not unusual. Dizziness is more dependent on which part of your brain was affected by the stroke. I don't think that either my fatigue, or my dizziness were as severe as your partner's, but, my balance was severe enough to prevent me from walking. Both  improved over time- for me, the fatigue got better in the first 2 yrs. post-stroke. The balance issues are much-improved, but still plague me. But, keep in mind that everyone is different when it comes to stroke recovery. Ask her doc about the meds she's on. Could any of them intensify or cause her symptoms? Has anyone told her doc about her constant nausea? You may be assuming that the NH has told her doc, but things get lost- 1st thinks 2nd shift told him, and 2nd thinks first told him, and 3rd doesn't know about her nausea because she's appropriately asleep when they're there.  It happens, unfortunately. Good luck, Becky

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Did her physician do a full audio and vestibular examination?  The reason is that the Cerebullar arteries provide blood for the ear (cochlea - audio, labyrinth - inner ear/vestibular).  If she had a cerebellar stroke, she could have damaged the ear.  Detecting infarct in the inner ear is very difficult to detect with contrast and highest powered MRI.  She could have the symptoms of ataxia (slurred speech, incoordination) as a TIA but feeling of nausea and  dizziness from the damaged ear.

 

The reason why I know that above is that I experience an aneurysm rupture by the brainstem which left me with single sided hearing loss and 40% deficiency of vestibular function on right side.  There are treatment options but it depends on the diagnosis.

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UPDATE/VENT : she is still sleeping a lot, but she has also gotten very combative. She refused PT 3 days in a row, so PT discharged her!  I am very upset about this! She is still getting OT and ST, although they left me a note today - so I don't know what that's all about. I suspect it's nothing good. She is also verbally abusing me, the aids, the nurses, and the admins. A couple of nights ago she threw something off her tray at an aid. She is not getting any better, and doesn't seem like she even wants to.

I struggle with depression, and her attitude and abuse is negatively affecting me and making it hard for me to function. I normally visit 2x a day, but I am going to have to back off for a couple of days to recharge, and I feel guilty about that. 
 

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http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/EmotionalBehavioralChallenges/Emotional-and-Behavioral-Challenges-After-Stroke_UCM_308549_SubHomePage.jsp 

 

Changes like that are sometimes said to be from her anger that she had a stroke and everyone just happens to be in her line of sight

It is also thought to be caused by the damage the brain gets from stroke ( blood loss,clots ...etc) 

 

Often you are told not to take it personally. Hard as that may be and because you hear things from the survivors POV and even though the caregiver/partner sacrifice a lot , often the the survivor is only focused with themselves. This is normal. The link above talks about the majority of time, the survivor has no idea they are being rude. I'm so sorry

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good luck. I was a SOB after and lost my filter. Many survivors lose theirs as well. so you may be one day out and she 'whispers'  or mildly yells " The place looks like sh*t"

 

Yeah I am notorious for that. I 'whisper' so well that people that live at the end of my city could possibly hear me hahahaha

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I know this may not be super helpful, but she needs to channel that anger and frustration into her rehab.  You only get back what you are willing to work for, which is why she would have been discharged from PT. There is limited therapy time and the staff ( and insurance etc.) are going to allocate that time to people who are going to participate and benefit from it. While the earlier she starts rehab the better, if she choses not to there's nothing you can do about it, and she can decide to do therapy later or somewhere else. Don't feel guilty about taking time for you, it sounds like she's going to need some "tough love" before she's ready to try and rejoin the human race.  Frustration and anger and throwing things are not uncommon reactions. But as you know they are not productive.  And deep down somewhere she probably knows this too.

 

Hugs and try not to take it personally.

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