Rafeef Khleif*, Faisal Khowaja*, Farzana Sumia*, Noor Alqaysi*, Shafaq Kirmani*

* American University of the Caribbean School of Medicine

In this clinical case, we are presenting a 78-year-old right-handed South Asian woman who was perfectly normal before? presenting with an acute-onset right side stroke, delirium, and becoming mute.  Neuroimaging showed a massive ischemic infarction extending over her left parietal, frontal,  temporal, insular cortex, and subcortical areas. She had no history of hypertension,  hyperlipidemia, or diabetes. 

She was put on antiplatelet therapy and anti-cerebral edema measures. 

It has been a month since the stroke. Although repeat MRIs continue to show poor left cerebral perfusion, her muscle strength on the right-side is still poor. Certain neuropsychiatric interventions in the patient management have started showing beneficial effects in the patient communication and outcome. 

In this brief report we will be sharing directions of management of elderly patients with dominant hemispheric damage recruiting the non-dominant hemisphere through neuropsychiatric approaches.