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Abstract: Patient Auntie Li, who had a history of hypertensive disease, developed vertigo and severe headache with nausea and vomiting, blurred vision in both eyes, followed by coughing and shortness of breath after a heated argument with a family member 5 days ago. He was rushed to the hospital by his family and was considered to have hypertensive encephalopathy after a complete cranial CT examination. The patient was given medication and oxygen therapy. After 3 days of treatment in the intensive care unit, her condition was stabilized and she was discharged after 4 days of transfer to a general ward.
Basic information】Female, 55 years old
Disease Type】Hypertensive encephalopathy
Hospital】Shandong Provincial Third Hospital
Time of consultation】May 2019
Treatment plan】Intravenous drug therapy (uradil hydrochloride injection + mannitol injection + glucose injection + 0.9% sodium chloride injection + metoprolol succinate extended-release tablets + nifedipine controlled-release tablets) + oxygen therapy
[Treatment period] 12 days of hospitalization, 1 month of follow-up by phone
Treatment effect】Stable condition and improvement of symptoms
I. Initial consultation
The patient came to the hospital in a critical condition. The family cried and said that there was a heated argument over a family matter, and the patient suddenly developed vertigo, severe headache, blurred vision in both eyes, accompanied by nausea and vomiting. The neurological examination was unconscious, and the examination was uncooperative. The above examinations suggest that hypertensive encephalopathy is a high possibility. Hypertensive encephalopathy is an acute and life-threatening condition. After communication, hospitalization was recommended, and the patient’s family expressed understanding and cooperation, and the patient was immediately transferred to the intensive care unit from the emergency room.
II. Treatment process
After admission, the routine blood, liver function, renal function, ion, lipid, blood glucose, cardiac enzyme examination were perfected, suggesting high renal function index and considering renal insufficiency. Cranial MRI+MRA examination did not show any significant abnormality. Fundoscopic examination of bilateral optic papillae edema. Blood pressure was persistently high, with high pressure fluctuating between 180-220 mmHg. Uradil hydrochloride injection was given to actively control hypertension, mannitol injection was given to dehydrate and lower cranial pressure, oxygen was given, and glucose injection and 0.9% sodium chloride injection were given for rehydration support. 6 hours later, high pressure dropped to about 150 mmHg. The patient gradually became conscious and still had sinus tachycardia, and was given increased metoprolol succinate extended-release tablets to regulate the heart rate. 3 days later the patient was stabilized and transferred out of the general ward, and was discharged after 4 days in the general ward and switched to nifedipine controlled-release tablets to control blood pressure.
III. Treatment effect
The patient had an acute onset and was in serious condition, but fortunately, he came to the hospital in time and had good results after 12 days of medication treatment without serious complications or sequelae. The patient was discharged from the intensive care unit after 3 days of close monitoring and combined treatment with drugs, and the patient’s vital signs were stable, blood pressure dropped to about 148/90 mmHg, and the headache was significantly reduced. The blood pressure control was stable.
IV. Notes
The patient’s recovery was good and we were happy for him. The patient and his family were advised to pay attention to any recurrence of headache, nausea, vomiting, unclear vision, etc. after discharge. If the above symptoms occur again, they should consult a doctor promptly; monitor blood pressure once a day in the morning and once in the evening; take medication on time as prescribed by the doctor and do not stop it blindly; eat a light diet, eat foods that are easy to digest and absorb, eat a high quality protein diet, pay attention to a low-salt and low-fat diet, and avoid eating spicy and cold foods; increase aerobic exercise, such as jogging, swimming, and Tai Chi, etc., after the condition stabilizes. After the condition stabilizes, you can increase aerobic exercise, such as jogging, swimming, Tai Chi, etc., for more than 30 minutes a day, and pay attention to regular follow-up at the hospital.
V. Personal insight
Patients with hypertension should pay attention to their blood pressure daily, actively control it and monitor it regularly, and keep their emotions stable to avoid sudden rise in blood pressure caused by emotional stress. Like the patient in this case, it is more than worthwhile to aggravate one’s disease due to family matters, so we should take this as a warning. In addition, family members should be more caring and less arguing with the elderly and encounter conflicts. In addition, this group of people should be focused on after discharge from the hospital, because this group of patients is a high-risk group for cerebral hemorrhage.