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Abstract: The patient was a 68-year-old grandfather who presented with confused speech without obvious cause 8 hours before admission and was diagnosed with cerebral infarction of the left temporo-occipital junctional area, a type of neurological dysfunction. With aphasia caused by cerebral infarction in the temporo-occipital junction, the patient mainly showed inability to understand what others asked, and the patient had difficulty in expressing his language and spoke with a telegraphic voice, while aphasia is a neurological dysfunction caused by damage to the brain’s language function center. After admission, the patient was given the appropriate medication, and the symptoms of speech disorder were eventually relieved.
Basic information】Male, 68 years old
Disease Type】Left temporo-occipital junction cerebral infarction
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Medication (haemodilution injection, shuxinin injection, sodium chloride injection, aspirin enteric dissolved tablets, rasulvastatin calcium tablets)
Treatment period】7 days of hospitalization and regular outpatient follow-up
Treatment effect】Speech confusion symptoms are relieved and the disease is well controlled
I. Initial interview
Eight hours before admission, the patient had confused speech without any obvious cause, unable to speak completely, unable to understand others’ questions, sometimes babbling, accompanied by weakness of the right side of the limbs, with persistent symptoms, difficulty in lifting the upper limbs, unable to walk on the lower limbs, no headache, no seizure, no incontinence, the patient’s family was very anxious, so he was admitted to our emergency room. The patient’s family was very anxious, so he was admitted to our emergency room. The patient and his family agreed to the admission, and after admission, the patient underwent magnetic resonance imaging of the head to identify the specific lesion, and blood was collected to check liver and kidney function, cardiac enzymes, troponin and other cardiac-related indicators, as well as blood homocysteine and bilateral carotid ultrasound. The patient had a history of hypertension and was taking oral nifedipine controlled-release tablets to control blood pressure, which was poorly controlled.
(Head MRI)
II. Treatment history
After admission, physical examination showed that: general condition was good, specialist examination showed that the patient was clear, incomplete mixed aphasia, bilateral pupils were equal in size and round, diameter was about 3.0 mm, light reflex was present and sensitive, bilateral upward and downward vision and other activities were normal, horizontal nystagmus was positive, tongue extension was to the right, right limb muscle strength was grade 3, right lower limb pathological signs were positive, head MRI showed cerebral infarction in the left temporo-occipital junction region. After the diagnosis was confirmed, the patient was given intravenous drip of blood sparing injection and ShuXinin injection, and sodium chloride injection to expand the volume.
III. Treatment effect
After 7 days of drug treatment, the patient reached the discharge indication, physical examination: the patient was clearly conscious, slightly clumsy speech, right limb weakness improved, and the patient’s general condition was better than before. Before discharge, the patient was advised to continue to apply antiplatelet and plaque stabilizing drugs, rehabilitation acupuncture in the rehabilitation department, to practice reading aloud to promote the recovery of language function, to eat less oily and salty food, to quit smoking and alcohol, to drink more water, and to exercise appropriately. 1 month later, outpatient follow-up was conducted.
IV. Notes
We are glad that the patient’s speech dysfunction gradually remitted after treatment. However, the patient’s impaired speech function, accompanied by limb weakness and numbness, is considered to be a watershed cerebral infarction, mainly due to insufficient cerebral perfusion. After discharge, the patient needs to pay attention to the patient’s condition, such as diarrhea, vomiting and other phenomena that can easily lead to insufficient blood volume, and if they occur, they need to follow up with the doctor in a timely manner. Patients also need to control blood pressure, because long-term hypertension and sudden decrease in blood pressure can lead to instantaneous blood supply insufficiency to the brain, resulting in infarction at the junction of two large vessels. After discharge, patients should also be advised to drink more water, eat a light diet, avoid a diet high in oil, salt and sugar, and recommend fresh fruits and vegetables. The patient’s speech function should be restored after discharge, just like teaching a child to learn to speak, which should be insisted on for a long time, and the family should be patient and careful.
V. Personal insight
The patient’s speech dysfunction was caused by cerebral infarction at the temporo-occipital junction, and cerebral infarction at the temporo-occipital junction is easily combined with headache and convulsions because it is close to the cortex, so the above symptoms should be closely monitored during the treatment. If the patient has significant headache and severe nausea and vomiting, the cranial CT should be reviewed immediately and dehydration and cranial pressure lowering treatment should be given. If the patient is combined with convulsions requiring antiepileptic treatment, this type of infarction is also prone to combined post-stroke depression, requiring antidepressant treatment and appropriate psychological counselling if necessary. The patient in this case deserves to learn from the fact that he did not choose to avoid the symptoms of discomfort when they appeared, but actively treated them, which also maximized the patient’s possibility of recovery.