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Abstract: Isotropic hemianopia is the meaning of visual field defect on one side of both eyes. When cerebral infarction involves the occipital lobe visual center and visual radiation, it may lead to this symptom, and cerebral infarction may also present with numbness and weakness of limbs, clumsy speech, double vision, headache and dizziness, etc. In this case, the patient came to the hospital with the above phenomena, and was diagnosed with isotropic hemianopia caused by cerebral infarction after examination. The symptoms were relieved after drug treatment.
Basic information】Male, 63 years old
Type of disease】Isotropic hemianopia caused by cerebral infarction
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
【Treatment plan】Medication (wake-up call injection + haemosiderin injection + lanugan injection + aspirin enteric dissolved tablets + atorvastatin calcium tablets) + psychological counseling and comfort + rehabilitation acupuncture treatment
[Treatment Period] 7 days of hospitalization, 1 month of outpatient review
Effectiveness of treatment】Reduced symptoms of isotropic hemianopia
I. Initial consultation
The patient developed blindness in the right side of both eyes with no obvious cause on the 7th day before admission, accompanied by memory loss and speech impairment, although he could understand other people’s questions and speak in full, but his speech was slurred. The symptoms worsened one day before admission, and there were no convulsions and no incontinence. The patient was admitted to the hospital today for a definitive diagnosis and treatment.
After admission, the patient was given CT head, biochemical series, routine blood tests, and ultrasound of bilateral carotid arteries. We learned that the patient had a past history of diabetes and was not taking oral hypoglycemic medication regularly. The examination results showed that the general condition was acceptable, the mental state was clear on specialist examination, the dysarthria was clear, the pupils were rounded bilaterally with a diameter of about 3.0 mm, the right side of both eyes was isotropic hemianopia, there was no facial palsy, the tongue extension was centered, the muscle strength of the limbs was acceptable, the tendon reflexes were symmetrical, there was no abnormality on sensory examination, the pathological signs of the right lower limbs were positive, the head CT showed multiple lacunar cerebral infarction and ischemic cerebral infarction in the left temporo-occipital lobe. The diagnosis was: isotropic hemianopia caused by cerebral infarction according to the examination results.
II. Treatment history
After the condition was clarified, the patient and his family expressed their willingness to actively cooperate with the treatment, so the patient was given cerebral protection with waking brain static injection, improved circulation with haematocrit injection and lanosterine injection, antiplatelet with oral aspirin enteric solution tablets and stabilized plaque with atorvastatin calcium tablets, as well as psychological counseling and comfort and rehabilitation acupuncture treatment.
III. Treatment effect
Through the combined treatment of the above drugs, the patient’s visual field defect and speech clumsiness were relieved in the 7-day treatment cycle, and he was discharged with a clear mind, fair speech and better mental outlook than before. Before discharge, the patient was advised to continue to take oral aspirin enteric solution tablets and atorvastatin calcium tablets and rehabilitation acupuncture treatment, as well as to pay attention to rest, drink more water, low salt and low fat diet, and to review regularly at the outpatient clinic after 1 month.
IV. Precautions
After the combination of medication and acupuncture, the patient’s symptoms of synoptic hemianopia were effectively relieved, and we are truly happy for the patient. In view of the fact that the patient has visual field loss on one side, he is often unable to see things on the front side, and he often runs into walls, bumps into others or even falls down when he walks, so it is recommended that he should pay extra attention to this in his life, try to be accompanied by others when he goes out, and avoid dangerous operations such as driving a motor vehicle.
At the same time, the treatment process of cerebral infarction should drink more water, reduce activities, actively cooperate with doctors for treatment, acupuncture rehabilitation can be carried out, in life should be low salt, low fat and low sugar diet, quit smoking and alcohol, appropriate exercise. Maintain a good and optimistic state of mind is more conducive to disease recovery, and do regular review.
V. Personal insight
In daily life, if there is numbness and weakness of limbs, clumsy speech, double vision, headache and dizziness, you must seek medical examination in time to clarify the specific cause of the disease, because there are more sudden symptoms caused by cerebral infarction, and serious ones will threaten their health, so early detection and early treatment are necessary. The patient with occipital lobe cerebral infarction is more likely to be combined with intra-infarct hemorrhage, so extra attention should be paid to regular re-examination of head CT and timely adjustment of medication if hemorrhage occurs.