Cerebellar Stroke Occupational Therapy and Physical Therapy Management from Intensive Care Unit to Outpatient: A Case Report.

Cerebellar stroke increases the risk of extensive physical disability and long-term institutionalization. The purpose of this case report is to describe the 14-month longitudinal rehabilitation management and outcomes from the intensive care unit, inpatient rehabilitation unit and outpatient care of a patient after cerebellar stroke. A goal of this case report is to provide rehabilitation clinicians with a long-term perspective and understanding of the course of recovery for a patient after cerebellar cerebrovascular accident or related injury. A 51-year-old healthy athletic female experienced acute bilateral cerebellar infarcts with subsequent craniotomy to remove infarcted areas. The patient had postoperative hemorrhages and hydrocephalus and was deemed to have a poor prognosis. Multimodal sensory stimulation and early mobility was performed until conventional neuromuscular reeducation interventions could be tolerated. Primary deficits included decreased proximal strength, whole body ataxia, vertical diplopia, dysphagia, difficulty communicating, and emotional lability. Fourteen months after the initial infarcts, the patient was able to reside in her own home with her husband, ambulate, and stand with assistance and perform most activities of daily living with standby or set-up assistance. This patient made significant progress toward safety and mobility and was able to return home despite the early discussion about a poor prognosis and a palliative care consultation. The complex, intensive course of rehabilitation elicited slow, steady, consistent gains. The patient's motivation and family involvement likely facilitated optimum outcomes.

Mycophenolate mofetil in dermatology.

UNLABELLED: Mycophenolate mofetil (MMF) is the prodrug of mycophenolic acid (MPA), a medication used to treat psoriasis in the 1970s until side effects and the concern of carcinogenesis led to its discontinuation. The prodrug, MMF, emerged decades later in the transplant field. Dermatologists have since used MMF off-label to treat various inflammatory skin conditions, with most research concentrating on its use in psoriasis, autoimmune blistering disorders, dermatitides, and connective tissue disorders. The appeal of MMF is predicated upon its lymphocyte specificity and consequent decreased toxicity profile. These attributes may make it a preferable treatment option. Its use in the field of dermatology is currently limited by a lack of randomized controlled trials, potential unknown side effects, and cost of treatment. In reviewing both current literature and our own clinic records, MMF appears to be a promising therapeutic option for the treatment of cutaneous inflammatory diseases. LEARNING OBJECTIVE: After completing this learning activity, participants should be able to summarize the history and pharmacology of mycophenolate mofetil as an immunosuppressant; recognize its potential role in the treatment of dermatologic conditions, including general dosing guidelines, use in pregnancy and pediatrics, and potential adverse effects; and identify future considerations and developing areas of research regarding the use of mycophenolate mofetil in dermatology.