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Abstract: A 63-year-old male patient suddenly developed limb weakness and fell to the ground during the course of household chores, and his family rushed him to the hospital, where he was suggested to have an ischemic stroke by perfecting one-stop CT. Ischemic stroke is an impairment of blood circulation in the brain due to various reasons. The patient’s neurological deficits were obvious and his condition was severe, and he was eligible for interventional thrombolysis.
Basic information】Male, 63 years old
Disease Type】Ischemic stroke
Hospital】Shandong Provincial Third Hospital
Date of consultation】June 2022
Treatment plan】Angiography + arterial thrombectomy + medication (aspirin enteric solution tablets + clopidogrel sulfate tablets + hemosiderin granules)
Treatment period】Inpatient treatment for 10 days, outpatient follow-up after 1 month
Treatment effect】Stable condition
I. Initial consultation
The patient was doing housework when she suddenly developed weakness in her limbs, then fell to the ground, and her speech was slurred. After consultation, a one-stop CT examination was completed, suggesting ischemic stroke, and neurological examination suggested drowsiness, right limb hemiparesis, and positive pathological signs. The patient’s current neurological deficits were severe, with progressive exacerbation, and the possibility of exacerbation of cerebral infarction was not excluded. The patient was given preoperative blood tests, electrocardiogram and chest X-ray, and contraindications to thrombolysis were excluded.
II. Treatment process
After the patient was admitted to the hospital, CT examination was completed and cerebral hemorrhage was excluded. The cerebral angiogram showed that the middle cerebral artery was severely occluded, and the distal image was shallow, so arterial embolization was performed immediately. After successful embolization, the patient was transferred back to the ward, and his vital signs were stabilized. Aspirin enteric solution tablets, clopidogrel sulfate tablets, and hemosiderin granules were given to improve circulation by antiplatelet aggregation.
III. Treatment effect
After arterial thrombolysis, the occluded blood vessel was recanalized and no serious ischemic necrosis of brain cells was formed. The patient’s consciousness became clear, and the symptoms of limb weakness improved significantly. The cranial MRI showed that most of the ischemic hemispheric zone was restored after active treatment, and the remaining infarct area was small. At the time of discharge after 10 days of hospitalization, the patient was neurologically assessed to be clear, with grade 4 limb muscle strength and a good treatment outcome. The patient was discharged after the improvement of his condition. 1 month later, he was reexamined in the outpatient clinic, and his condition was stable, with limb muscle strength of grade 4+ and no other special discomfort.
IV. Notes
We are glad that the patient’s condition is stable after treatment, but the recurrence rate and disability rate of this disease are high, and regular review is more critical, so we should visit the neurology department regularly to improve the monitoring of high-risk factors to assess the intracerebral situation and adjust the treatment plan in time. After discharge from the hospital, patients should reasonably control blood pressure, blood sugar and blood lipids, and pay attention to any symptoms of dizziness, headache, slurred speech and lack of limb movement. While taking anti-platelet aggregation drugs, attention should be paid to the presence of subcutaneous petechiae and gum bleeding, and if so, aspirin enteric tablets should be discontinued and neurology follow-up. In general, patients should pay attention to enhance physical exercise, such as jumping rope, swimming, running, etc. They should also pay attention to nutrition, more vitamin supplements, pay attention to quit smoking and alcohol, avoid second-hand smoke, pay attention to avoid staying up late, straining, and emotional anxiety.
V. Personal insight
Ischemic stroke is a serious health hazard for the elderly in China, and once it occurs, it can cause serious disability and even endanger life. In this case, the prognosis is good because the patient was seen in time, so it is necessary to have regular medical checkups. If a family member has symptoms of neurological deficits, such as language function, cognitive function, limb function, etc., he or she should be actively sent to the hospital for early treatment. Early surgery to open the occluded blood vessels can effectively avoid ischemic necrosis of brain cells, which is beneficial to the patient’s recovery and avoid sequelae.