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Abstract: Aphasia refers to the inability of a patient to recognize previously familiar objects without visual, auditory, or somatosensory impairment and with normal consciousness, including visual aphasia, with lesions mostly located in the occipital lobe; auditory aphasia, with lesions mostly located in the bilateral middle superior temporal gyrus and its auditory contact fibers; and tactile aphasia, with lesions mostly located in the bilateral parietal angular gyrus and the superior limbic gyrus. In the present case, the patient had a temporoparieto-occipital infarction resulting in visual agnosia, and after drug treatment, the patient recovered well and her agnosia symptoms improved.
Basic information】Female, 55 years old
Type of disease】Acute cerebral infarction, anosognosia
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (mannitol injection, glycerol fructose injection, edaravone injection, compound amino acid injection, danshen chuanduozin injection)
Treatment period】7 days of hospitalization
Treatment effect] The symptoms of anosmia were relieved and the patient was discharged successfully.
I. Initial consultation
Five days before admission, the patient did not recognize pencils, fruit knives, TVs and other familiar objects. The family complained that the patient’s vision was normal, but when asked what the objects were, he did not know them and could not name familiar people. One day before admission, the patient showed weakness of the left limb and spoke with a big tongue, which attracted attention and came to our outpatient clinic. After a brief examination, neurological diseases were considered, and a head CT examination showed bilateral lacunar cerebral infarction. The patient had a 10-year history of diabetes mellitus and poor glycemic control.
II. Treatment history
After arranging the ward, the patient entered the ward for detailed physical examination, was conscious, incomplete mixed aphasia, blood pressure: 160/100 mmHg; heart rate: 87 beats/min. Take out pencil and key and ask the patient, the patient could not name the object by looking at it, let the patient touch it with his hand and name the object accurately after touching it. Left limb muscle strength grade 3, anxiety scale score of 4, depression scale score of 3. Functional disorders were basically excluded, and head MRI was performed to show large cerebral infarction in the right temporal, parietal and occipital lobes and cerebral arteriosclerotic stenosis. The patient’s cranial vascular status and infarct area were evaluated in detail. The patient was given mannitol injection and glycerol fructose injection to lower cranial pressure by alternating dehydration and regular rechecking of renal function and ion; compound amino acid injection was given for rehydration; edaravone injection was given for cerebral protection; danshen chuan douzin injection was given to improve circulation; antiplatelet therapy was also given.
(Head magnetic resonance)
III. Treatment effect
Through 7 days of active treatment, the patient’s anosognosia symptoms were relieved. The patient was able to name some familiar objects, such as spoons and chopsticks, but there were still some objects that could not be recognized visually. The patient’s left limb lifting was higher than when he was admitted to the hospital, and the fine activity impairment was relieved, and the discharge indications were reached. The patient was instructed to continue treatment at the rehabilitation hospital as soon as possible. The patient had high blood glucose at the time of admission, and after completing 7 times of blood glucose and glycated hemoglobin, she asked the endocrinology department to consult and regulate her blood glucose, and her blood glucose was well controlled at the time of discharge.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. The patient’s inability to name familiar visual objects in the past is considered to be caused by large cerebral infarction, and the patient’s previous high blood pressure. Since the patient’s intracranial vascular compensation state is still acceptable and there has not yet been an aggravating fluctuation of the lesion, the blood pressure should not be lowered too much during the acute phase of cerebral infarction, otherwise it will easily lead to insufficient cerebral perfusion to aggravate cerebral infarction. After passing the acute phase smoothly, regular blood pressure measurement and regular oral antihypertensive drugs are needed. Daily low-salt and low-fat diet should be taken to ensure the amount of fluid and quit smoking. Meanwhile, pay attention to the complications of cerebral infarction, such as crushing pneumonia, pressure sores, and cerebrocardiac syndrome, etc. If symptoms such as cough and skin lesions appear, it is recommended to seek medical follow-up promptly. In the later stage, rehabilitation exercises should be carried out appropriately, which requires long-term persistence of family members as well as patients.
V. Personal insight
Visual loss is not due to visual problems, but is mostly related to damage to the occipital visual center. Visual loss of recognition includes object loss, inability to recognize familiar objects, face loss, inability to recognize familiar family members and friends, and color loss, inability to correctly distinguish red, yellow, blue, green and other colors, etc. It mainly needs to be distinguished from body image disorder, which mainly refers to patients with normal basic perceptual functions, but lose the ability to discriminate the presence of their own body, spatial location and the relationship between various parts. If patients have visual loss, they should not take it lightly and should seek medical consultation to identify the cause and treat it in a timely manner.