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Abstract: This 77-year-old Zhang suddenly developed limb movement, Zhang is an old undergraduate patient, with a history of cerebrovascular atherosclerosis, the current situation, more than the possibility of transient cerebral ischemic attack, advised Zhang after timely medical treatment, given to improve circulation anti-platelet aggregation drugs, Zhang’s symptoms have improved, the condition is stable and discharged.
Basic information】Male, 77 years old
Disease Type】Transient Ischemic Attack
Hospital】Shandong Provincial Third Hospital
Time of consultation】May 2022
【Treatment plan】Intramuscular injection (hemosiderin injection) + oral medication (aspirin enteric solution tablets + clopidogrel sulfate tablets + cytarabine sodium capsule)
Treatment period】7 days of outpatient treatment, 1 week of outpatient follow-up, 1 month of telephone follow-up
Treatment effect】Stable condition, symptoms have improved
I. Initial consultation
This is an old neurology patient who regularly comes to the neurology department for review. Last night, I received a phone call from him, saying that he had suddenly experienced the lack of movement before, but he was fine again after about 5 minutes. Because this patient had a history of multiple arterial stenosis with atherosclerosis, the possibility of transient ischemic attack was considered, and the patient was advised to be admitted to the hospital for examination.
The patient was admitted to the hospital for urgent examination of routine blood, coagulation function, electrocardiogram, cranial MRI and other examination items. The routine blood coagulation function did not show any significant abnormalities, and the electrocardiogram suggested a normal electrocardiogram. Cranial MRI showed mild cerebral atherosclerosis with MRA and limited luminal stenosis of the right anterior cerebral artery. The neurological examination showed no obvious positive signs, and the patient was recommended to be hospitalized to avoid aggravation of transient cerebral ischemic attack and formation of cerebral infarction, and the family expressed understanding and actively cooperated with the hospitalization.
II. Treatment history
Transient cerebral ischemic attack is generally caused by cerebrovascular atherosclerosis, which leads to transient cerebral cell ischemia and hypoxia, resulting in signs of neurological dysfunction. It can manifest as dizziness, limb immobility, abnormal limb sensation, slurred speech, choking and coughing with water. According to the patient’s examination results, outpatient treatment can be given to the patient, and the patient is suggested to perform oral medication with intramuscular injection treatment. After communicating with the patient’s family, aspirin enteric tablets and clopidogrel sulfate tablets are given to antiplatelet aggregation, with intramuscular injection of hemosiderin injection to improve circulation, and cytarabine sodium capsule is given to improve brain metabolism.
III. Treatment effect
The patient’s symptoms of limb immobility did not reappear after the treatment, and her general condition was good with stable vital signs. The patient was discharged from the hospital after 7 days of hospitalization with no other complications or adverse drug reactions and stable vital signs. 1 week later, the patient had no other special discomfort at the outpatient clinic and was followed up by telephone one month later.
IV. Notes
We are glad that the patient’s condition is under control. Transient ischemic attack, if not treated in time, can lead to cerebral infarction formation, which can lead to disability in serious cases. Early active intervention is very necessary. Patients need to be advised that they need to actively monitor blood pressure and blood glucose after being discharged home, and blood pressure should be controlled above and below the level of 130/90 mmHg. Regular follow-up visits to the neurology department and regular evaluation of cranial MRI and angiography are required. Pay attention to low-salt and low-fat diet, quit smoking and alcohol, avoid excessive stress, and eat easy-to-digest food. Increase physical exercise, such as jogging, etc.
V. Personal insight
The transient ischemic attack in this elderly patient could be improved quickly, the focus is on the patient’s timely treatment, good compliance with medication and good cooperation, so many adverse consequences were avoided. However, among the cases treated clinically, some elderly people choose to hide or not go to the hospital after the symptoms appear because they are afraid of delaying their children’s affairs. Later on, because of the formation of cerebral infarction will appear to aggravate the symptoms. Instead, the loss is not worth the gain. Family members should pay more attention to the situation of the elderly and urge them to express their symptoms in time and actively seek medical treatment in order to achieve good treatment results.