600 Section - Severe Stroke in a Young Patient with Antiphospholipid Syndrome: A Five-Year Functional Recovery Profile

Left intracerebral hemorrhage in a 26-year-old woman, complicated by cerebral edema requiring decompressive craniectomy, leading to right hemiparesis, sensory deficits, expressive aphasia, dysphagia, right upper-limb spasticity, and post-stroke epilepsy in the context of antiphospholipid syndrome.

Case Description: A now 31-year-old woman suffered an abrupt, severe posterior-cervical and left-sided headache five years earlier, accompanied by projectile vomiting and ocular pain. She was diagnosed with a hemorrhagic stroke and underwent emergent surgical evacuation. Her postoperative course included cerebral edema requiring decompressive craniectomy, meningitis, right-sided motor and sensory impairment, aphasia, dysphagia, and generalized tonic-clonic seizures.
During two inpatient rehabilitation admissions, she progressed from nasogastric feeding to full oral intake, gradually regained speech, and showed functional recovery. She transitioned from wheelchair dependence to independent ambulation, requiring a cane only for long distances, and increased her weight from 37 kg to 52 kg. Right upper-limb spasticity limited functional hand use; therefore, handgrip strength was measured on the left (28 kg).
At current physiatry follow-up, she reports intermittent pulsatile headaches, occasional imbalance, and independence in personal care. She continues outpatient physical therapy, speech therapy and occupational therapy, remaining on warfarin for antiphospholipid syndrome.

Discussions: This case illustrates the complex long-term rehabilitation trajectory after severe hemorrhagic stroke requiring decompressive surgery in a young adult. Multidisciplinary interventions addressing motor deficits, aphasia, dysphagia, seizure management, and emotional recovery were essential. Strong family support further facilitated reintegration.

Conclusions: Despite severe initial neurological injury and postoperative complications, coordinated interdisciplinary rehabilitation enabled significant long-term functional recovery. This case reinforces the vital role of sustained physiatric follow-up and comprehensive outpatient therapy in maximizing independence after severe stroke.