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Abstract: An 81-year-old patient accompanied by his family came to the hospital with a significant headache, measured blood pressure showed 220/110 mmHg, and vomiting symptoms. The family complained that the patient had no history of hypertension, but a history of gastric ulcer was present, so the initial diagnosis was hypertensive encephalopathy with upper gastrointestinal bleeding. After admission, the possibility of upper gastrointestinal bleeding was ruled out by perfect examination, and the diagnosis of hypertensive encephalopathy was clarified. Therefore, medication was given to improve the patient’s symptoms and control the blood pressure steadily.
Basic information】Female, 81 years old
Disease Type】Hypertensive encephalopathy (hypertensive encephalopathy)
Hospital】Beijing Tiantan Hospital
Date of consultation】September 2020
Treatment plan】Oral medication (nifedipine tablets, amlodipine benzoate tablets) + intravenous medication (compound mannitol injection, Gu Hong injection, Ozagrel sodium injection) + nasal catheter oxygenation
Treatment period】2 weeks of hospitalization
Treatment effect] Symptoms improved and blood pressure was stable.
I. Initial consultation
The patient was an 81-year-old female who was accompanied by her family to the clinic. When we first saw the patient, she had a headache, and her blood pressure was measured and showed 220/110 mmHg. When asked about the patient’s specific situation, the patient’s family informed him that his blood pressure had increased in recent years, but considering the patient’s age, they all thought it was normal and therefore no special treatment was given. When the patient came to the clinic, he had been suffering from headache for 1 week, and the pain was increasing, and yesterday he started vomiting, so he came to the clinic. We asked the patient about his past medical history and learned that he had no previous history of diabetes and had a history of gastric ulcer for many years. Therefore, based on the patient’s symptoms and medical history, he was initially diagnosed with hypertensive encephalopathy with upper gastrointestinal bleeding, and was admitted to the hospital for treatment.
II. Treatment history
After admission, the patient was given TCD, carotid ultrasound, and routine blood tests, all of which were in the normal range, and the possibility of upper gastrointestinal bleeding was excluded, so the final diagnosis was hypertensive encephalopathy. After the diagnosis was confirmed, considering the patient’s age and the heavy degree of cerebrovascular atherosclerosis, he was given nifedipine tablets to lower blood pressure, followed by intravenous injection of compound mannitol to lower intracranial pressure and Gu Hong injection to improve blood circulation.
After a period of time, the patient’s blood pressure was lower than before, and amlodipine benzoate tablets were given to further lower the blood pressure, while nasal catheter oxygen was administered. After the condition entered a stable phase, the intravenous drip of compound mannitol injection was stopped and replaced with sodium oxyglactin injection to improve cerebral blood supply, and Gu Hong injection was continued to be applied to improve myocardial blood supply by static dosing.
III. Treatment effect
On the day of admission, the patient’s blood pressure gradually decreased to 170/90 mmHg after taking the medication, but the headache and vomiting symptoms were still present. On the second day of treatment, his blood pressure was measured and showed 150/80 mmHg, which was significantly lower than when he was first admitted to the hospital. The patient reported that his headache was significantly relieved, the frequency of vomiting was significantly slowed down, dizziness remained, and chest tightness with mild pain occurred after climbing stairs or light exercise. After 2 weeks of hospitalization, the patient reported that the headache and vomiting disappeared, and the blood pressure was stable in the normal range, controlled at 120/80 mmHg, indicating that the patient’s blood pressure was well controlled, and he was discharged from the hospital for recuperation.
IV. Notes
We are glad that the patient’s clinical performance gradually improved after active treatment. For the sake of the patient’s health, the following points should be instructed to be noted in the patient’s daily life when discharged.
1. In life, patients are advised to develop good habits of work and rest and avoid staying up late to avoid poor blood pressure control. In addition, in the early stage of discharge should try to avoid strenuous exercise, overexertion, to be stable blood pressure, and then according to their own situation appropriate exercise, you can choose to walk, etc., to help stabilize the condition.
2. After discharge from the hospital, patients should still take oral amlodipine benzoate tablets to maintain stable blood pressure, and should regularly test their blood pressure and seek medical consultation if there is any abnormal increase in blood pressure.
3. In terms of diet, patients should eat more vegetables and fruits rich in vitamin C and potassium, such as bananas, apples, spinach, etc., which help control blood pressure and improve blood circulation. In addition, patients should also eat more fiber-rich foods, such as corn and brown rice, to prevent constipation.
V. Personal insight
Hypertensive encephalopathy is a sudden rise in blood pressure that causes compulsory dilation of the brain arteries and impairment of cerebral circulation, resulting in headache, drowsiness, vomiting, and even impaired consciousness. In this case, the patient had hypertension before he was diagnosed, but his family and himself did not pay attention to it, so he was never treated effectively to control blood pressure. He came to the clinic with a severe headache and vomiting, and only then did he realize the importance of hypertension. Fortunately, the patient was treated promptly without serious consequences, and the prognosis of the patient was more satisfactory.