In brief: This case report describes a 32-year-old bodybuilder who sustained an ischemic cerebrovascular accident and showed signs of cardiomyopathy. No cause was found for either condition, but he had been using steroids for 16 years. Questions remain about the association between the two conditions and steroid use, and the full effects of long-term, high-dose steroid use have yet to be elucidated. As steroid use becomes more popular among athletes, the medical community must be alert to the possible adverse effects of these substances.
Dysphagia, with its inherent risk of aspiration, is a clinical problem frequently encountered in patients with brain injury from trauma or cerebrovascular accident. The use of nasogastric tubes and intravenous lines for nutrition and hydration can be cumbersome and uncomfortable for the patient, and can interfere with rehabilitation therapy. With the advent and increased use of video- and cinefluoroscopy to evaluate swallowing, the type of dysphagia can be defined more readily. This article describes the use of a heparin lock at night to provide fluids intravenously to a patient who could swallow solid or semisolid food, but aspirated thin liquids. This approach insured adequate hydration while keeping the patient free of parenteral lines and nasogastric tubes during therapy. This technique was continued for 3 1/2 weeks until the patient's dysphagia improved and a full oral diet could be resumed. The authors recommend the use of nighttime intravenous feeding via a heparin lock as an option for managing this subset of dysphagic patients in a rehabilitation setting.
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