(Disclaimer: This article is for scientific use only, and the relevant information in the following content has been processed in order to protect the privacy of Master Zhang)
Abstract: The main character of this case is 64-year-old Master Zhang, who presented to our hospital with left-sided limb weakness, inability to lift the upper limb and walk on the lower limb without any obvious cause. The examination revealed that the muscle strength of the affected limb was grade 4, and he had underlying diseases such as hypertension and diabetes mellitus in the past and smoked for many years. The head magnetic resonance examination was perfected and showed: acute stage cerebral infarction, cerebral artery stenosis and hemiparesis in the lateral ventricle. After admission, the patient was given medication, and his symptoms were relieved, and his condition was stable with good recovery.
Basic information】Male, 64 years old
Disease Type】Heparesis, acute paraventricular cerebral infarction, cerebral artery stenosis
Hospital】The Second Hospital of Harbin Medical University
Date of Consultation】February 2022
【Treatment plan】Medication (blood sparing injection, lanchin injection, bacitracin injection, oral cerebral protein hydrolysate, atorvastatin calcium tablets, valsartan tablets)
[Treatment period] Hospitalization for 8 days, regular follow-up review
Effectiveness of treatment】Limb weakness has been relieved and the condition is stable
I. Initial consultation
The left side of the limb was weak, the upper limb could not be lifted, the lower limb did not walk, there was no clumsy speech, no tinnitus, no hearing loss, no impaired consciousness, no convulsions, and Zhang and his family were very anxious, so he was admitted to our clinic. He had a history of hypertension, but did not take oral antihypertensive medication regularly. The emergency head CT showed bilateral lacunar infarcts, and no clear responsible lesions were seen. The family regretted that they could not perform thrombolytic therapy because they missed the thrombolytic time window (6 hours), and they were reassured and immediately hospitalized.
II. Treatment process
After admission, the patient was examined: body temperature: 36.2℃, blood pressure: 160/90mmHg, heart rate: 76 beats/min, respiration: 16 breaths/min, the patient was clear, fluent in speech, and the muscle strength of the left limb was grade 4. Magnetic resonance imaging of the head showed: acute stage cerebral infarction with cerebral artery stenosis in the right lateral ventricle. The symptoms worsened on the second day after admission, and the muscle strength of the left side of the limb was grade 2. The symptoms of acute cerebral infarction might be aggravated, and bactrim injection could be used to control the disease progression as much as possible, but there was a certain risk of bleeding, and the family members should be aware of this. The blood circulation was improved and blood viscosity was lowered by sparing blood injection; the circulation was improved by dengjianxin injection; fibrinogen was degraded by bactrim injection; brain protein hydrolysate oral solution was given to improve brain metabolism; atorvastatin calcium tablets lowered blood lipids; and valsartan tablets lowered blood pressure.
(Head magnetic resonance)
III. Treatment effect
The patient is still unable to lift the upper limb, but can walk with the help of the lower limb. Although the symptoms of Zhang’s hospitalization have worsened, I, as the attending physician, patiently check the body and explain the condition of Zhang every day, Zhang gradually accepted and cooperated with the treatment, the condition gradually stabilized, the patient is in good condition, and the limb movement disorder is improving. The patient’s condition gradually stabilized, the patient is in good condition, the limb movement disorder also continues to improve, the acute stage told Zhang moncler outlet online less down to the ground activities, drink more water. The patient’s condition was not aggravated in the next few days, so he had passed the dangerous period and reached the discharge indication.
IV. Notes
We are glad that Zhang’s symptoms have improved after treatment, but because of the weakness of one of his limbs and the similar degree of paralysis of the upper and lower limbs, combined with the MRI, we consider that the lateral ventricular cerebral infarction is the cause, so after discharge, it is feasible to practice simple extension of the upper limbs and flexion of the lower limbs, and put the upper and lower limbs in a functional position, and usually try to lie down mainly, and need family support when going to the toilet to avoid falling down and fracture. In addition, the diet should be appropriate for each meal, not too full, not overeating, recommended to eat high-quality protein, such as fish, beef, etc. Quit smoking and limit alcohol, but do not drink too much, especially strong alcohol, alcohol may promote cerebral atherosclerosis, may cause strong vascular reaction, vasomotor dysfunction.
V. Personal insight
Cerebral infarction is a highly disabling disease and the symptoms are often aggravated at the beginning of the disease, as in the case of Master Zhang. All in all, since Zhang has experienced exacerbation, stabilization and recovery, his psychological process is also very difficult, and he still needs to adjust after discharge from the hospital.