Abstract
Glenohumeral Subluxation (GHS) is one cause of shoulder pain after stroke. The greater the distance of GHS, the higher is the chance of rotator tendonitis or tearing of the tendon, causing limited motions and excruciating pain. Cross Cerebellar Diaschisis (CCD), a reduction of blood flow in the contralateral cerebellum after the supratentorial stroke, is detectable by a brain perfusion scan, and it has marked impacts on functional outcomes after stroke. We presented here a case on hemiplegic stroke. CCD of the patient persisted for 7 months without improvements. The patient underwent measurement of GHS and Single Photon Emission Computed Tomography to confirm the characteristic relationship. The patient’s GHS persisted for a prolonged period of time during which the acromiohumeral distance was longer than those of the general CCD-free stroke. Together with persisted CCD, the persistence of GHS was correlated with a prolonged CCD, which is presumably one sign of motor deficits associated with CCD.
Highlights
Patients after stroke often display symptoms like aphasia, half neglect, limb hemiplegia, abnormal sensation, cognitive impairment, imbalance, and brainstem or cerebellar dysfunction
Regarding causes of shoulder pain, reports are related to lesions of the rotator cuff tendons, central poststroke pain, lack of sensibility, unilateral neglect, spasticity, reflex sympathetic dystrophy, and inferior-anterior subluxation of the head of the humerus [1]
The second Brain Ethyl Cysteinate Dimer (ECD)-Single Photon Emission Computed Tomography (SPECT) showed Cross Cerebellar Diaschisis (CCD) remaining on the right side, but not the prior hyperperfusion in the right thalamus (Figure 1)
Summary
Patients after stroke often display symptoms like aphasia, half neglect, limb hemiplegia, abnormal sensation, cognitive impairment, imbalance, and brainstem or cerebellar dysfunction. In a recent study on functional electrical stimulation for treating shoulder pain in stroke patients, Karaahmet et al found a positive correlation between GHS and pain (P= 0.022) [5]. A 52-year-old woman, upon waking up from a nap on 2018/04/12, suddenly suffered from an unsteady gait and reduced body sensation on her right side She was soon sent to a local medical center. During the following 6 to 7 months, the patient experienced right-sided hemiplegia while still able to walk slowly by herself under supervision. Her pain in the right shoulder persisted, even after aggressive rehabilitation for 5 months, including steroid injections to the right GH. The second Brain ECD-SPECT showed CCD remaining on the right side, but not the prior hyperperfusion in the right thalamus (Figure 1)
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