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Abstract: The patient had a history of multiple cerebral infarction and cerebral hemorrhage in the past, with residual symptoms such as numbness and weakness of the limbs. After treatment with drugs to improve circulation and cerebral metabolism, the symptoms of memory loss were relieved, and the disease did not progress and was stable.
Basic information】Male, 78 years old
Disease Type】Dementia
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Medication (Awakening Brain Jing Injection, Blood Seton Injection, Shuxinin Injection, Piracetam Tablets, Donepezil Hydrochloride Tablets)
Treatment period】7 days of hospitalization
Treatment effect】The symptoms of memory loss were relieved, the disease did not progress, and the condition was stable.
I. Initial consultation
Family description: Half a month before admission, the patient gradually appeared to be unresponsive and had memory loss. Afterwards, he felt slow in communicating with the patient, forgot what he ate for breakfast at night, and could not remember some previously familiar phone numbers clearly, but his hand and foot movement disorder did not worsen, his speech disorder did not worsen, and he had no nausea or vomiting. When the patient was asked how much 100-7 equals, the patient thought for about 10 seconds before saying 93, and when asked how much 7 equals, the patient was unable to calculate. The patient was unable to calculate the number when asked how much 7 equals. The outpatient clinic improved the head CT examination: bilateral multiple cavernous infarcts and some lesions were softened. The patient’s family was informed that the patient was recommended to be admitted to the hospital for further examination, and was informed that the patient had a past history of hypertension and diabetes, a past history of multiple cerebral infarction and cerebral hemorrhage, and left-sided limb weakness and speech impairment.
II. Treatment history
On admission: clear consciousness, dysarthria (not aggravated from before), near memory loss, calculation loss, and executive loss. Body temperature: 36.3°C, blood pressure: 160/90 mmHg, heart rate: 85 beats/min, respiration: 18 breaths/min, left limb muscle strength grade 3. The patient was given a complete cranial magnetic resonance examination showing: bilateral multiple cavernous infarcts, DWI without diffusion restriction, and multiple stenotic occlusions of cerebral arteries. Dementia scale score: 20 points (total score 30). No acute cerebral infarction or cerebral hemorrhage was considered, but vascular dementia was considered due to a history of multiple previous strokes and cognitive dysfunction on this occasion.
The patient and his family were introduced to the condition and the treatment plan was to use drugs to improve brain metabolism and cognitive function, to which the family agreed. Cerebral protection was given with Awakening Brain Quiet injection, Haematocrit injection to help improve circulation, Shuxin injection to improve circulation, Piracetam tablets to improve memory, and Donepezil hydrochloride tablets to improve cognitive function.
(Cranial magnetic resonance)
III. Treatment effect
After 7 days of hospitalization, the symptoms of memory loss were relieved, the disease did not progress, and the condition gradually stabilized. The patient’s family was informed that no restriction of diffusion was seen in this cranial MRI, and no acute cerebral infarction or cerebral hemorrhage was considered, but due to the history of multiple previous strokes, cognitive dysfunction occurred this time, and vascular dementia was considered. After discharge, oral medication and regular review are still required. The patient’s family was very cooperative with the treatment during hospitalization and was instructed to teach the patient to calculate after discharge to help improve cognitive function.
(Cranial magnetic resonance – discharge)
IV. Notes
We are glad that the patient’s memory loss symptoms have been relieved after treatment. After discharge, the patient first needs to control the risk factors of cerebrovascular disease, because the patient has had several strokes in the past, leaving sequelae such as impaired physical activity and clumsy speech, and this time, the onset of personality change indifference combined with medical history is considered vascular dementia. In the early stage of vascular dementia, the patient may not have much impact on life. Patients are encouraged to participate in more social activities and carry out some activities that are conducive to intellectual improvement, such as calligraphy and creative writing. In the later stage, as memory declines, the patient may not be able to take care of himself, and should avoid activities alone, as it is easy to get lost. Diet should be light, with more protein and vitamins.
V. Personal insight
The patient in this case has vascular dementia with multiple recurrent strokes resulting in a decline in whole brain function and affecting cognitive function. The patient needs to actively control the risk factors that cause cerebrovascular disease, such as blood pressure, blood sugar and blood lipids. For physicians, clinical work needs to distinguish between various causes of dementia, such as Alzheimer’s dementia, which is predominantly memory impairment, frontotemporal dementia, Lewy body dementia, Parkinson’s disease dementia, etc., and give corresponding treatment plans for different causes.