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Abstract: Transient ischemic attack is clinically considered as a precursor of cerebral infarction, which can also be interpreted as a yellow card warning from the body that a stroke may occur at any time and should be treated promptly at a hospital. As in the present case, the patient, a 42-year-old male, was admitted to the hospital with episodes of right-sided facial and right hand and right foot numbness for 3 days. Eventually, transcranial Doppler ultrasound and CT were performed, and the diagnosis was transient ischemic attack with hypertension and diabetes mellitus. After drug treatment, the patient’s condition was controlled and his speech as well as motor function improved.
Basic information】Male, 42 years old
Disease Type】Transient ischemic attack, diabetes mellitus, hypertension
Hospital】Jixi City People’s Hospital
Date of Consultation】March 2022
Treatment plan】Medication (aspirin extended-release tablets, risuvastatin calcium tablets, valsartan capsules, butylphthalide soft capsules, bactrim injection, menthol insulin 30 injection, shuxin injection, oxytetracycline sodium injection)
[Treatment period] Hospitalized for 14 days
Treatment effect]: The disease was controlled, speech clumsiness and physical dysfunction were improved, and blood pressure and blood sugar were controlled smoothly.
I. Initial interview
The patient was admitted to the hospital with episodes of right-sided facial, right hand and right foot numbness for 3 days. The patient reported: within 3 days before admission, numbness of the right side of the face, right hand and right foot appeared without obvious cause, with 3 episodes, each lasting about 2-3 minutes, with a feeling of salivation at the corners of the mouth during the episodes, and the symptoms could be completely relieved after a few minutes. No symptoms such as limb dysfunction. In the morning of the day of admission, the patient again experienced numbness in the right face, right hand and right foot, which lasted for about 10 minutes and then relieved the symptoms.
After admission, he was asked about his past medical history in detail: the patient’s blood pressure was usually high, up to 170/90 mmhg, but he did not take any antihypertensive medication because he did not feel uncomfortable. In the past year, he had frequent weakness and thirst, and had lost about 5 kg of weight. The patient was examined in detail: blood pressure 160/85 mmHg, clear, fluent speech, normal vision, no visual field defects, clear boundary of the optic papilla, no edema in the fundus, bilateral pupils equal to the circle, sensitive to light reflex, full freedom of bilateral eye movement, no nystagmus, bilateral nasolabial fold symmetry, tongue extension in the center, bilateral limb muscle strength grade 5, normal muscle tone, normal facial and limb sensation, symmetrical tendon reflexes of the limbs The pathological signs of both lower limbs were negative. The patient underwent relevant examinations: routine blood tests showed no abnormality, liver function showed glutamyl transpeptidase 105.8u/L, renal function showed no abnormality, blood glucose was 7.83mmol/L, triglycerides 4.6mmol/L, coagulation phase showed plasma fibrinogen measurement 4.56g/L, head and neck vascular ultrasound showed that the intima-media of bilateral carotid arteries was not smooth and multiple sclerotic plaques formed at the bifurcation of head and arm trunks. Sclerotic plaque formation. The transcranial Doppler ultrasound showed changes in the spectrum of cerebral atherosclerosis, and the cranial CT showed no significant abnormalities. The preliminary diagnosis was “transient ischemic attack”.
II. Treatment history
The patient had frequent attacks recently, and the coagulation panel showed that the patient had elevated fibrinogen, which is a high-risk factor for stroke, so the patient was given fibrinogen-lowering treatment with bactrim injection, which can reduce the level of fibrinogen in the blood. When administered intravenously, it reduces whole blood viscosity and plasma viscosity, which decreases vascular resistance and increases blood flow. Coagulation routine was rechecked before each application, and the patient’s coagulation image showed fibrinogen of 1.92 g/L before the second application, and treatment with bactrimase injection could be discontinued. After discontinuing bactrim, the patient was given Ozagrel sodium injection, which can improve the motor disorder in the acute phase of cerebral thrombosis, improve the circulatory disorder in the acute phase of cerebral ischemia and improve the abnormal energy metabolism in cerebral ischemia, and the drug has an inhibitory effect on platelet aggregation due to different causes and has a preventive effect on cerebral infarction caused by cerebral artery obstruction. Aspirin extended-release tablets were also given orally to prevent atherosclerotic plaque rupture and thrombosis. The patient was given intravenous drip of Shuxin injection, together with the use of butylphthalide soft capsule orally, which could significantly improve the microcirculation and blood flow in the patient’s cerebral ischemic area, increase the number of capillaries in the ischemic area, inhibit thrombus formation, etc. The drug was stopped after 20 days of administration. In addition, the patient was found to have triglycerides of 4.6 mmol/L on lipid examination at the time of admission, and was given a statin, Rosuvastatin calcium tablets orally to lower lipid therapy.
The patient had previous symptoms of wasting, weakness and thirst, and the blood glucose was 7.83 mmol/L on admission. The patient was considered to be diabetic, and was given a further glucose tolerance test: the blood glucose two hours after meal was 15.61 mmol/L, which could diagnose the patient as diabetic. Because of the manifestation of atherosclerosis and cerebral ischemia, the patient was given insulin glucose-lowering treatment with menthol insulin 30 injection to regulate blood glucose after communication with the patient and his family. The patient’s blood pressure was high and could reach hypertension level 2. After admission, the blood pressure was monitored between 150-160/85-90 mmHg, and the patient was diagnosed with diabetes, so after the patient’s condition gradually stabilized, the patient was given valsartan capsules to lower blood pressure.
III. Treatment effect
Three days after admission, the cranial MRI showed that the left paraventricular space was formed, and no significant high signal was seen in DWI. After treatment of fibrinogen lowering, antiplatelet aggregation, lipid regulation and plaque stabilization, blood pressure and blood sugar stabilization, and improvement of cerebral circulation, the patient did not have any more episodes of symptoms such as numbness in the head, face, right hand and right foot. Blood pressure was controlled between 125-135/85-90mmHg, fasting blood sugar was between 5.0-7.0mmol/L, and two hours after meal blood sugar was controlled between 7.0-8.5mmol/L. The patient’s discomfort was significantly relieved. After 2 weeks of treatment, the patient’s condition was basically controlled and he was discharged successfully.
IV. Notes
I felt happy from the bottom of my heart when I saw that the patient’s symptoms were significantly relieved. I advised the patient to pay attention to reducing activities, avoiding exertion and emotional excitement after discharge, because the unstable plaque can be dislodged to form thrombus and cause cerebral infarction due to adverse external stimulation. Daily water intake can be increased appropriately to ensure cerebral blood perfusion. At the same time, improve living habits, achieve a low-salt and low-fat diet, quit smoking and alcohol, and increase exercise appropriately after discharge, while reducing weight. Take antihypertensive drugs and insulin on time, monitor blood pressure and blood sugar, and carry sugar cubes to prevent hypoglycemia. In addition, after discharge from the hospital, regularly review liver function, kidney function, creatine kinase, urine routine, glycosylated hemoglobin, etc., in order to monitor the presence of drug damage and disease control. Pay attention to any bleeding gums, stomach pain, stool color, etc., and seek medical attention if there is.
V. Personal insight
The high-risk factors of transient ischemic attack mainly include bad life habits, such as smoking and drinking, heavy diet, little exercise, staying up late and straining, mental tension, etc., and some underlying diseases such as hypertension, diabetes, hyperlipidemia, etc. are even higher risk factors to cause it. Like the patient in this article, is a unit of sales staff, usually in order to busy business, in order to socialize often to restaurants, and irregular diet, for business is also tobacco and alcohol. In the discovery of high blood pressure, and think they are young and do not have any problems and do not take drugs. As a result, over time, three highs appeared, which, together with the enablers of smoking and drinking without exercise, eventually led to the occurrence of transient cerebral ischemic attack. It should be said that the patient was fortunate enough to realize the importance of controlling the underlying disease after the occurrence of transient ischemic attack, and after controlling the underlying disease and improving the bad living habits, the symptoms were finally relieved and the development of cerebral infarction was avoided, and I feel very relieved. Therefore, after the occurrence of transient ischemic attack, we should receive the signal given to us by our body in time and go to the hospital in time.