—— A thought triggered by a patient’s real experience With the arrival of severe winter, the temperature dropped significantly and the number of stroke patients coming to our department for treatment increased significantly. Some of these patients tend to take some oral medications on their own or given by their family members at the onset of stroke, while some medications are not only unsuitable for early treatment of stroke, but can even cause serious consequences. The following is a real case: The patient Zhao, male, 61 years old, presented with headache and weakness of the right limb without any obvious cause, still able to walk. At that time, his blood pressure was 180/90mmHg, and his family members, who are slightly skilled in medicine, immediately gave oral antihypertensive drugs, and his blood pressure dropped to 120/80
At that time, the symptoms worsened significantly, and he was unable to speak and his right limb was paralyzed, so he was rushed to the local hospital for cranial MRI examination, which showed multiple infarct lesions in the left basal ganglia and temporoparietal lobe. With the improvement of public health awareness, the increase of medical and health care knowledge, and the popularization of small medical devices such as blood pressure meters and glucose meters, some patients and their families began to actively apply their limited medical knowledge to carry out pre-hospital treatment within their capabilities, but they often fell into the misunderstanding of treatment due to the unprofessional nature of their operation. From the pre-hospital emergency in this case, the aggressive antihypertensive treatment at the onset may have been the cause of further aggravation of the patient’s symptoms, resulting in an aggravating effect. From clinical experience, a significant proportion of patients with cerebral infarction or TIA (transient ischemic attack) exhibit elevated blood pressure at the onset of the attack, which is usually explained by the protective response of the body triggered by the ischemia of brain tissue, and the increase in blood pressure can increase the blood perfusion of brain tissue, thus relieving the symptoms. If the blood pressure is lowered rapidly at this time, it may interrupt the body’s self-protection mechanism, accelerate the progress of the disease and delay the treatment. In general, it is not necessary to actively lower blood pressure after acute infarction if it does not exceed 220/120 mmHg, but for clinical safety reasons, a more appropriate range such as systolic blood pressure not exceeding 180 mmHg or slightly higher than the basal blood pressure may be chosen. Although the control of blood pressure in the first few days after stroke is controversial, the dangers of rapid blood pressure lowering in the early stages are certain and therefore the recommendation from stroke treatment guidelines is to avoid rapid blood pressure lowering (e.g. nifedipine) and to lower blood pressure gently and smoothly if necessary. Stroke treatment is a complex and specialized task, and blind medication may do a disservice with good intentions, causing damage that is sometimes difficult to undo. There are also misconceptions in the pre-hospital treatment of cerebral infarction: the patient’s symptoms are relieved on their own after the attack without going to the hospital, thinking that the symptoms will improve and the disease will improve, missing the best time for treatment; or just looking for infusion in a small clinic without going to the hospital for further examination. The best time for treatment will also be missed, and once the condition develops further, it may lead to serious consequences.