Narayanappa is a 45 year old male who was working as a driver. He was referred to Bhagwan Mahaveer Jain Hospital on 14/09/2017 with the chief complaint of altered sensorium due to binge drinking alcohol. He was admitted in ICU for emergency care and rehabilitation. He is a known case of chronic alcoholism. His MRI scan showed Left sided MCA infarct leading to Right sided hemi paralysis.

During his ICU stay, he underwent Frontal Temporal Parietal decompressive craniotomy on 15/09/2017

He was on ventilator support, nasogastric tube for feeding and an indwelling catheter during his ICU stay. Patient showed poor awareness of the surrounding environment, difficulty in functional use of bilateral upper limb and lower limb for daily life activities, dependent for ADL task, behavioral issues- non-cooperative and aggressiveness. He also had poor compression and expression of speech.
After 2 months of Neurorehabilitation, patient gradually progressed from an unconscious and aggressive phase to a cooperative and wakeful phase. He had withdrawal symptoms because of which he was having behavioral issues. His participation in rehab became better and improved day by day. He gained independent sitting and standing ability. His upper extremity strength improved. He was able to carry out essential activities of daily living. He was weaned of the tracheostomy after 2 months, as he could sustain adequate breath support and reduced secretions. His speech became less repetitive and more purposeful. His swallowing reflex improved, he was able to take all oral feeds without difficulty.