Disclosures: Mina S. Gayed, DO: No financial relationships or conflicts of interest

Case Description: An 83-year-old man presented to acute rehabilitation after suffering a large left parietal stroke. The patient had left homonymous hemianopsia from his prior stroke, and now he had a new right sided visual field deficit from his current stroke. The visual field deficits complicated his rehabilitation as he communicated via sign language. The patient had aphasia given that his family and sign language interpreters had difficulty. Patient reverted to communicating via Hungarian Sign Language as opposed to American Sign Language. He was initially lethargic with poor intake due to his dysphagia diet requiring a PEG tube. After receiving enough nourishment, his energy levels dramatically increased; however, the team later noted severe agitation. The patient suffered from Charles Bonnet Syndrome (CBS), a disorder characterized by hallucinations in older individuals with impaired vision. This agitation extended towards therapy staff and family. Since the patient had been on chronic sertraline therapy, he was treated with ziprasidone which was tapered as he improved.

Setting: Inpatient rehabilitation stroke unit

Patient: An 83-year-old congenitally deaf male with left homonymous hemianopsia from prior right parieto-occipital stroke who suffered a severe left parietal stroke. Assessment/

Results: The active customized medical treatment in our acute rehab program made it possible for our patient to achieve maximal medical and functional recovery by enabling him to participate in his therapies and maximizing his stay.

Discussion: For our patient with Charles Bonnet Syndrome and concomitant agitation, we found that an atypical antipsychotic was beneficial for symptom management and promoting participation in therapy. Current literature lists several options for CBS including selective serotonin reuptake inhibitors and antiepileptic medications. For our patient, ziprasidone was chosen to address his agitation.

Conclusion: Stroke rehabilitation is very complex especially for individuals with premorbid auditory and visual deficits. It is important to tailor medical treatment to meet the individual needs of the patient.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-customized-stroke-rehab-program-for-an-individual-with-both-auditory-and-visual-deficits-a-case-report/