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Abstract: When cerebral hemorrhage occurs, it may cause numbness and weakness of the limbs, headache and dizziness, nausea and vomiting, and impaired consciousness, etc. It may also lead to visual field loss in one side of both eyes and isotropic hemianopia. In this case, the patient came to the clinic with blurred vision in both eyes, speech impairment, and numbness and weakness in the right side of the limbs, and was diagnosed with isotropic hemianopia caused by cerebral hemorrhage. After drug treatment, the patient’s symptoms improved and the visual field defect was restored.
Basic information】Male, 46 years old
Type of disease】Isotropic hemorrhage caused by cerebral hemorrhage
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
【Treatment plan】Medication (wake-up call injection + sodium ganglioside injection + edaravone injection + spearhead viper hemagglutinase injection + glycerol fructose injection + vitamin B1 tablets) + psychological counseling and comfort
[Treatment Period] 9 days of inpatient treatment, regular outpatient review after 1 month
Treatment effect] The symptoms of isotropic hemianopia were relieved and the disease was controlled.
I. Initial interview
The patient was admitted to the hospital 15 hours before the onset of blurred vision in both eyes without any obvious cause, walking in a straight line, easily deviating to the left, detailed questioning of the patient complained that now he sees things differently in his eyes than before, as if the right side is missing, accompanied by speech impairment, can understand others’ questions, can say complete words, slurred, with the right side of the limbs numbness and weakness, the upper limbs can be lifted, the lower limbs can walk, with headache, no dizziness, no nausea, no vomiting, no convulsions. He came to our hospital for a definite diagnosis and treatment, and was subsequently admitted.
After admission, the patient was given CT head, biochemical series, routine blood tests, bilateral carotid ultrasound and other tests. We also learned that the patient had a history of hypertension, poorly controlled blood pressure, and had been smoking and drinking for many years. The examination results showed that the patient was in good general condition, clear consciousness, dysarthria, free movement of both eyes, isotropic hemianopia in both eyes, no facial palsy, no abnormal sensory examination, positive pathological signs in the lower extremities of the right lower limbs, and head CT showed cerebral hemorrhage in the left temporal lobe.
II. Treatment process
After communicating with the patient and family members about the patient’s specific situation, it was decided to give brain protection by wake-up call injection, nerve nutrition by ganglioside sodium injection, anti-free radical by edaravone injection, hemostasis by spearhead viper hemagglutinase injection, and dehydration by glycerol fructose injection, as well as psychological counseling and comfort.
III. Treatment effect
Through 9 days of drug treatment, the patient’s visual field defect, clumsy speech and limb weakness symptoms were relieved, and his mental outlook was better than before. Considering that the patient had no other clinical symptoms and discomfort, the patient was granted discharge. The patient was also instructed to use vitamin B1 to nourish the nerves, maintain a low-salt and low-fat diet after discharge, control blood pressure, and review regularly at the outpatient clinic after 1 month.
IV. Notes
We are glad that the patient’s symptoms have improved significantly and her condition has been effectively controlled after medication. It is recommended that in addition to following the doctor’s prescription, the patient should have regular medical checkups to monitor her condition in a timely manner. In addition, when going out, try to be accompanied by others to avoid encountering danger. After discharge from the hospital, pay attention to rest, avoid emotional excitement, avoid straining to defecate, and if symptoms of discomfort occur, or if the original symptoms worsen, seek medical attention in a timely manner, and if it leads to a large amount of cerebral hemorrhage, surgical treatment is required. In life, you should have a low-salt, low-fat, low-sugar diet, quit smoking and drinking, and exercise appropriately. You can do some low-intensity aerobic exercises, such as walking and Tai Chi.
V. Personal insight
Since the patient has temporal lobe energy disorder with clumsy speech and weakness of the right limb, good results can usually be achieved by supplementing B vitamins, such as vitamin B1 tablets, on top of conventional dehydration, cerebral protection, hemostasis and other drugs used to treat cerebral hemorrhage. However, it should be noted that patients with temporal lobe cerebral hemorrhage, like this patient, are prone to combined psychiatric symptoms, such as shouting and hitting, etc. Families need to pay extra attention to this, and regularly go to the hospital to review the head CT, and need timely neurosurgical treatment if the bleeding volume is large.