Andrijono-Cerebral hemorrhage sequela-(Indonesia)
Name: Andrijono 
Sex: Male
Country: Indonesia
Age: 57
Diagnoses: 1.Cerebral hemorrhage sequela 2. Hypertension level-3 (very high risk) 3. HHCY-hyperhomocysteinemia 4. Chronic renal insufficiency
5. HLP (hyperlipidaemia)
Days Admitted to the Hospital: 28
Andrijono had weakness in both right limbs without an obvious cause starting in 2008. The weakness began in the right lower limb and extended to the right upper limb. He went to the local hospital immediately to have this checked out. He was given a CT examination which showed a high density shadow in the left basal ganglia and thalamus. During this time Andrijono was diagnosed with a cerebral hemorrhage (left basal ganglia and thalamus). After 3 weeks of conservative treatment, the muscle strength and movement in the limbs gradually increased but he was still unable to walk independently. He received physical rehabilitation training for 1 week which improved his walking ability quite a bit but the muscles in the right leg were still weak and as a result, caused him to walk with a hemiplegic gait. He insisted on receiving physical rehabilitation training since the onset of his condition.
When we first examined Andrijono, he was alert and in good spirits. His memory, orientation and calculation abilities were normal. The convergence reflex of both eyes was not very good. The hearing in the right ear had declined. The muscle strength of the right upper limb was level 5-. The muscle strength of the right lower limb was level 4+; the muscle tone was slightly high. The muscle strength of both left limbs was level 5, the muscle tone was normal. The stiffness in the right limbs was obvious when Andrijono tried to do some exercises. He felt sharp pain when his right hand would make a fist and the movements of the right hand were uncoordinated. The deep and shallow sensation in both right limbs was noticeably diminished. The deep sensation in the right knee joint was not elicited. The tendon reflex of both upper limbs was active. The right patellar tendon reflex was active, but the left patellar tendon reflex was reduced. The bilateral Achilles tendon reflex was reduced. The bilateral abdominal reflex was not elicited. The bilateral palm jaw reflex, Hoffmann's sign and Rossolimo��s sign were negative. The Babinski's sign on the right side was neutral. The Babinski's sign on the left side was negative. The right upper limb could finish the finger-to-nose test and rapid rotation test, but at a slow pace. The left upper limb could finish the digital opposition test and rapid rotation test at a normal pace. The right lower limb could finish the heel-knee-shin test, but in an uncoordinated manner. The left lower limb could finish the heel-knee-shin test normally.
Andrijono received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves. He also had autologous stem cell therapy and had his resistance strengthened. He received daily physical rehabilitation training.
At present, the convergence reflex of both eyes has improved as well as the hearing in the right ear. The hearing in the right ear is almost as good as the left. The muscle strength of the right upper limb's distal-end is level 5; the muscle strength of the right lower limb is level 5-. The muscle tone of both right limbs has been reduced slightly from before. The stiffness in both right limbs has been noticeably alleviated. The sharp pain he previously felt in the right hand has disappeared when he holds objects. His right hand is more flexible and can do various fine movements such as grasping thin articles of clothing and smaller objects. The tendon reflexes of both upper limbs and the patellar tendon reflex of the right lower limb have decreased slightly. The deep sensation in the right lower limb beneath the knee has been elicited. Andrijono's walking posture has improved.
