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Abstract: A 65-year-old patient presented with unprovoked right-sided limb weakness, which worsened the next day with symptoms such as inability to sit still, slurred speech, choking on water, and difficulty in eating, etc. The symptoms further worsened after medication was given at a local hospital, so he came to the clinic. After examination, the patient was diagnosed as having smog syndrome, also known as smog, and was given medication and rehabilitation training to control her condition and recover her symptoms.
Basic information】Female, 65 years old
Type of disease】Smoke syndrome
Hospital】Hubei Third People’s Hospital
Date of consultation】December 2020
Treatment plan】Medication (butalbital sodium chloride injection + edaravone dextran injection with concentrated solution + aspirin enteric tablets) + rehabilitation treatment
Treatment period】10 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The condition was controlled and the hemiplegic limb recovered well.
I. Initial interview
The patient’s right limb weakness appeared on December 20, 2020 with no obvious cause, manifested as unstable walking, and the next morning the patient’s right limb weakness was worse than before, the patient was bedridden, unable to sit still, poor mental health, with slurred speech, choking and coughing, difficulty in eating, no dizziness, headache, nausea, vomiting, no limb convulsions, and was seen at the local hospital. Acute cerebral infarction. Subsequently, he was given aspirin enteric solution tablets for antiplatelet aggregation and atorvastatin calcium tablets for lipid regulation and plaque stabilization. However, the weakness of the right limb gradually worsened, and the patient became conscious, and was referred to our department for consideration of progressive cerebral infarction, and arteriosclerosis was considered as the cause in combination with the patient’s age.
II. Treatment history
This kind of patient is more common, and the family repeatedly thought that the patient had been in good health only with recurrent headache, and also had transient left leg weakness a few years ago, and got better after a few days of dilation injection. The CTA results showed that the patient’s blood vessels were a mess, and the patient’s family was told that the cause of the cerebral infarction might be smog, and it was suggested to improve angiography to clarify the cause. The patient’s family understood and immediately completed the angiography, which clarified the cause.
III. Treatment effect
After the patient was given anticoagulation therapy with the comprehensive treatment of improving collateral circulation, scavenging oxygen free radicals and rehabilitation, the patient’s symptoms were significantly improved. 10 days after admission, the patient was clear, answering the questions with ease, and the strength of the hemiplegic limbs was also significantly improved, and he could walk with support, and the patient’s frequent headache symptoms were also improved. After 1 month, the patient could walk with crutches at the outpatient clinic.
Notes
We are glad that the patient’s symptoms were relieved after treatment. We suggest that the patient should still take oral medication according to the doctor’s prescription after discharge, and should not change the medication at will, especially the anticoagulant medication, and should continue to take butylphthalide soft capsule orally for 2 months to improve the lateral circulation and strengthen the self-rehabilitation. The golden rehabilitation time is the 1st month. Patients should exercise every muscle of the hemiplegic limb every day so that the rehabilitation can be effective. Normally, patients should quit smoking and alcohol, avoid emotional excitement and strain to avoid stimulation leading to vasospasm induced disease. When the patient’s condition is stable, surgery can be considered.
V. Personal insight
Smoker’s disease is a rare cerebrovascular disease with a current trend of increased incidence, which is associated with heredity. If the patient’s elders have a history of stroke, it is recommended to improve cerebrovascular examination early to clarify the presence of smog, and early detection can be surgical treatment to remove the cause of the disease. Early treatment can save the foci of cerebral ischemia, and the patient’s limb hemiparesis can be better treated.