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Abstract: A 65-year-old male patient was admitted to the hospital with a sudden onset of headache with nausea and vomiting during activity and elevated blood pressure of 182/93 mmHg, accompanied by numbness and weakness of the extremities, and a cranial CT suggesting thalamic cerebral hemorrhage. Early treatment can reduce the rate of death and disability. This case was surgically treated by minimally invasive removal of intracranial hematoma, and the condition was controlled.
Basic information】Male, 65 years old
Type of disease】Hypertensive cerebral hemorrhage
Hospital】Shandong Provincial Third Hospital
Date of Consultation】March 2021
Treatment plan】Minimally invasive removal of intracranial hematoma
Treatment Period】Hospitalization for 13 days, outpatient follow-up after six months
Effectiveness】The bleeding was absorbed and the condition was controlled.
I. Initial consultation
A 65-year-old male suddenly developed a headache with nausea and vomiting during his chores about 6 hours ago for no apparent reason, and the vomit was stomach contents, accompanied by numbness and weakness of the right limb. After checking the patient’s vital signs and clinical symptoms, the patient was considered to be an intracranial emergency, and immediately improved the cranial CT examination, ECG, routine blood count, liver and kidney function, and cardiac enzyme laboratory examination.
II. Treatment
After comprehensive assessment, the patient was diagnosed with hypertensive cerebral hemorrhage because he was bleeding in the main functional area with large bleeding volume and obvious signs of neurological dysfunction. The patient’s current vital signs were stable, blood pressure had been actively controlled, and there were no other contraindications to surgery. After consulting with a neurosurgeon, it was recommended to actively perform minimally invasive removal of intracranial hematoma. The results of early surgery would be better. We then communicated with the family in detail about the risks and necessity of surgery, and explained that other complications might occur during surgery, such as re-expansion of bleeding, increased bleeding volume, and other complications such as myocardial ischemia and cerebral infarction might occur at the same time. At that time, the family still had some hesitation, but after the director of neurology communicated again, the family agreed and actively arranged the surgery. Due to the patient’s good general condition, timely detection and disposal, and accurate localization of the hematoma, the surgery was smooth.
III. Treatment results
After early active surgical treatment, this patient had better drainage of intracranial hemorrhage, better postoperative recovery, no obvious complications, significant improvement in neurological dysfunction, and disappearance of headache, nausea, and vomiting symptoms. The patient was discharged after 13 days of hospitalization. The patient reported that there were no obvious signs of neurological dysfunction, and was advised to actively control blood pressure to avoid recurrence of cerebral hemorrhage, to follow up with the neurology department in six months, and to review cranial MRI and angiography regularly every year.
IV. Notes
After this surgery, we are glad that the patient recovered well and did not have any significant sequelae. However, because long-term hypertension has led to arteriosclerosis, the patient is still at risk of rebleeding and therefore needs long-term monitoring and active blood pressure control. Regular review at the hospital is required to avoid recurrence of cerebral hemorrhage. And patients are advised that in order to avoid recurrence of the disease or triggering other diseases, they need to quit smoking and alcohol, maintain a light diet, and avoid overeating and eating large amounts of fatty meat. It is also recommended that patients should actively engage in appropriate sports, such as walking, after discharge from the hospital to help improve their physical fitness.
V. Personal insight
Hypertensive cerebral hemorrhage is common in middle-aged or older patients with poor control of blood pressure. The most typical symptoms are hemiparesis, hemiplegia, and hemianesthesia, which are usually not preceded by aura and may be accompanied by headache, acute disease accompanied by neurological dysfunction, and in severe cases, coma and even life-threatening. It is necessary to actively send the patient to the doctor, as in the case of the patient, the symptoms were effectively relieved after active treatment. Therefore, it is recommended to quit smoking and drinking, avoid staying up late and straining, and at the same time develop good habits. People who like to smoke and drink should go to the hospital regularly to check the blood vessels in the brain and assess the probability of cerebrovascular occurrence. Early intervention and treatment are required to avoid the occurrence of the disease.