Multimodal therapeutical-rehabilitative approches in a complex case of pathology including possibly evolving discariotic type- case report.

Abstract

Introduction Having the patient’s consent and The Teaching Emegency Hospital “Bagdasar-Arseni” Ethics Committeee N.O 20270 from 26.06.2019, the current case report presents the case of a female patients with both hemiplegia following a thalamic vascular accident and a long history of neglected auricular melanoma. The management of a patient diagnosed with melanoma is a complex one, involving wide local excisions with safety margins, with sentinel lymph node biopsy. Auricular melanomas have recently evolved from radical procedures involving the amputation of the involved organ, to much less radical procedures, which help save more of the patient’s tissue and functionality. (1) Another important factor that threatens the rehabilitation process in the case of hemiplegic patients is the presence of clinical depression, both as a pre-existing comorbidity and as a common psychiatric complication of stroke. (2) Depression jeopardizes the patient’s quality of life and increases mortality. (2) There is also relevant date supporting the hypotheses that depression history is associated with melanoma risk, although no effect on survival was observed. (3) Materials and Methods A 70 years old pacient, which suffered right thalamic vascular accident in december 2018 was admitted in our Neuromuscular clinic division with the following comorbidities: basal-cell carcinoma (BCC), diagnosed 20 years ago, with slow evolution. When admittedin our division, the pacient presented with a moderately large ulcerated tumor in the temporal region and the left auricular pavilion – with surgical indication. She was also diagnosed with arterial hypertension stage III, chronic, cardiac insufficiency class III NYHA, chronic cervicalgia and lumbosacralgia, class II obesity, clinical depression. She was admitted into our clinic for hemiplegic motor deficit, sensibility disorders, severe locomotor and self-grooming dysfunction. Results The patient improved on most of the assessment scales/scores implemented in our Clinic’s Division Motor FIM (Functiona Independence Measure) from 35/91 to 38/91, FAC (Functional Ambulation Categories) from 0/5 to 1/5, GOS-E (The Extended Glasgow Outcome Scale) from 4/8 to 5/8. The most important improvemet in our patent’s evolution was her ability to start walking again. During her admission into our Clinic, she was also briefly admitted into the hospital’s Plastic Survery Divison, where she received the necessary surgical trateament for the melanoma. Conclusions Following a complex neuro-recovery program developed by a multidisciplinary team made of doctors, kinesio-therapists, middle and allied health personnel, the patient had an extremely good evolution (during a short period of time) - attested on the scales and also - on a psycho-cognitive and behavioral level. Key words: neuromuscular rehabilitation, stroke, hemiplegia, melanoma, basal-call carcinoma,