Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Neurological Rehabilitation

Hemorrhagic Stroke in Elderly Female Following Kidney Transplant: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Tyler Hwang, Other

    Medical Student
    Georgetown University School of Medicine
    Bethesda, Maryland

    • Co-Author(s)

  • LM

    Laura Malmut, MD

    Assistant Professor
    MedStar National Rehabilitation Network
    Washington, District of Columbia

  • MA

    Mona Amin, MD (she/her/hers)

    PGY3 Resident
    Medstar Health/Georgetown-National Rehabilitation Hospital PM&R Program
    Washington, District of Columbia

Disclosure(s):
Tyler Hwang, Other: No financial relationships to disclose
Laura Malmut, MD: No financial relationships to disclose
Case Diagnosis: An elderly female with a recent uncomplicated kidney transplant—typically linked to reduced stroke risk—presented with a right thalamic hemorrhagic stroke due to hypertensive emergency and was transferred to inpatient rehabilitation.

Case Description or Program Description: A 70-year-old female presenting with mild left hemiparesis was found to have hypertensive emergency and right-sided hemorrhagic stroke. Her history included Type 2 diabetes, hypertension, and a renal transplant five months prior for chronic kidney disease with a functioning graft. CT imaging revealed an acute intracranial hemorrhage in the right thalamus and posterior limb of the internal capsule without midline shift. She was managed medically without surgical invention and eventually transferred to inpatient rehabilitation for risk factor management and functional recovery. During her 14-day stay, blood pressure medications were titrated to a goal of < 130 mmHg, and glycemic control was managed with dietary modifications.

Setting: Inpatient Rehabilitation Unit

Assessment/Results: The patient participated in a multidisciplinary rehabilitation program, progressing from Minimal Assistance to Independent. By discharge, she achieved target blood pressure and glycemic control. She was advised to follow up with neurosurgery and endocrinology.

Discussion (relevance): Kidney transplantation reduces ischemic stroke risk compared to end-stage renal disease (ESRD) patients on dialysis due to improvements in uremic toxin clearance, better fluid and blood pressure management, and reduced systemic inflammation. However, studies suggest the risk for hemorrhagic stroke, particularly in patients over 65, remains elevated post-transplant due to persistent vascular changes and comorbidities. This case highlights that post-transplantation benefits do not fully mitigate hemorrhagic stroke risk. Immunosuppressive-induced endothelial dysfunction, cardiovascular risk factors, and suboptimal blood pressures likely contributed to stroke risk. These findings underscore the importance of individualized risk stratification and rigorous monitoring in elderly transplant recipients to minimize cerebrovascular risks.

Conclusions: Elderly patients with recent kidney transplants remain vulnerable to hemorrhagic stroke despite overall reduced cerebrovascular risk. Comprehensive management addressing post-transplant physiological changes is critical.