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Abstract: Multifocal cerebral infarction is generally an ischemic infarction at multiple sites due to cerebrovascular lesions and requires active interventional treatment. The patient was found to have multifocal cerebral infarction on physical examination and currently has no clinical symptoms. Further improvement of blood sampling and laboratory tests, liver and kidney function, ion, lipid and blood glucose examinations, and improvement of cerebrovascular examination suggested cerebral arteriosclerosis and high blood pressure, and active control of hypertension and administration of drugs to nourish brain cells and improve brain metabolism, the patient’s condition was stable and symptoms improved.
Basic information】Male, 63 years old
Disease Type】Multifocal cerebral infarction
Hospital】Shandong Provincial Third Hospital
Date of consultation】May 2021
Treatment plan】Medication (nifedipine controlled-release tablets, piracetam dispersible tablets, haematocrit tablets, resulvastatin calcium tablets)
Treatment period】18 days of hospitalization, 1 month of outpatient follow-up
Treatment effect】Stable condition, symptoms have improved
I. Initial consultation
The patient came to the clinic with a reluctant face, his children brought him here, and the patient kept saying it was fine, no need to see. After asking the patient if he had any previous history of hypertension and diabetes, he was advised to improve the cranial MRI angiography to assess the intracerebral situation, and the results suggested cerebrovascular atherosclerosis with mild stenosis, and the blood test results suggested poor blood sugar control. The initial diagnosis of multifocal cerebral infarction was made in the outpatient clinic. It was suggested that blood pressure and blood glucose should be actively controlled, and medication to improve cerebral circulation, anti-platelet aggregation and brain cell nutrition should be given.
II. Treatment history
The patient’s cranial magnetic resonance examination suggested multifocal cerebral infarction with small lesions, which was consistent with his age. stenosis. In view of the risk of cerebral infarction, preventive medication such as nifedipine controlled-release tablets, piracetam dispersible tablets, hemosiderin tablets, and resulvastatin calcium tablets are recommended, which need to be taken for a long time and reviewed regularly. The patient expressed understanding and actively cooperated with the treatment, and was discharged from the hospital after 18 days of treatment, and the blood pressure and blood glucose were controlled to normal range in the outpatient clinic after 1 month, and the condition was stable.
III. Treatment effect
Multifocal cerebral infarction is mostly due to chronic insufficiency of blood supply caused by cerebrovascular lesions, which leads to ischemic infarction of brain cells in multiple locations, with small infarction sites and generally no obvious clinical symptoms. However, such patients have a high risk of cerebral infarction and need to be actively monitored for high-risk factors and actively controlled with long-term medications, such as Rosuvastatin calcium tablets, Piracetam dispersible tablets, and Blood Certis tablets to prevent exacerbation of cerebrovascular disease. The patient’s condition is stable after taking the medication, the high-risk factors are controlled in the normal range, the blood pressure is relatively stable, and the blood glucose is controlled in the normal range through diet regulation and increased exercise. It is recommended to regularly improve the brain MRI examination for regular evaluation, and if symptoms appear, promptly go to the hospital and give medication, and it is recommended to follow up every 3 months.
IV. Notes
We are glad that the patient’s condition has improved through treatment. Patients should exercise moderately during medication treatment, actively control high-risk factors, pay attention to keeping warm when the seasons change, and avoid overworking and staying up late. The aerobic exercise can be increased appropriately, such as running, rope skipping, swimming, the need to quit smoking and alcohol, diet, advocating a light diet, low salt, low fat. During the medication period, if signs of neurological dysfunction such as limb inactivity and slurred speech occur, you should actively visit the hospital to avoid the formation of cerebral infarction. Regular annual checkups and cranial MRI should be conducted to assess the condition of the brain as well as cerebral vessels and whether the medication regimen needs to be adjusted. Medications should be taken regularly and on time. If other symptoms occur, such as cognitive function decline, medications to improve cognitive function should be increased, and blood routine, liver and kidney function, blood lipids and blood sugar should be rechecked at the hospital every 3 months to avoid side effects of medications.
V. Personal insight
Multifocal cerebral infarction is common in middle-aged and elderly patients, which refers to the more widely distributed sites of cerebral infarction, and generally the lesions are small and will not have obvious clinical symptoms, suggesting chronic cerebral blood supply deficiency and the possibility of cerebral atherosclerotic lesions, which require further improvement of examination to assess the cerebral vessels and require active drug intervention to avoid cerebral infarction. If the atherosclerosis is mild, it can be treated conservatively with internal medicine; if the vascular lesion is heavy, it needs to be treated surgically; regular checkups to improve the relevant examination and control the high-risk factors are what the elderly need to do to avoid the aggravation of cardiovascular and cerebrovascular diseases.