(Disclaimer: This article is for scientific purposes only, information in the following content has been processed to protect patient privacy)
Abstract: Disorientation is not a form of mental illness, but it can make people stupid. 60-year-old man suddenly started to ramble while working, and did not know where he was, could not call out his friend’s name correctly, and did not even know which season he was in. After a series of medications, the patient’s disorientation symptoms were alleviated and he was successfully discharged.
Basic information】Male, 60 years old
Disease Type】Orientation disorder
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Medication (cytarabine sodium injection + wake-up call injection + mannitol injection + edaravone injection + lanchin injection)
Treatment period】8 days of hospitalization
Treatment effect] Disorientation symptoms were relieved
I. Initial consultation
The patient showed up at 20 hours with non-answering questions, did not recognize her daughter, did not understand where she was, talked to herself from time to time, no limb tremor, but the limbs could move, the family was very anxious about this and immediately brought the patient to our hospital. After initial observation of the patient, we found that she was slightly irritable and could not cooperate with physical examination. When we asked the patient where she was at that time, she replied that she was at a relative’s house, but she could not name the specific relative. Based on the patient’s clinical manifestations, it was initially determined to be a manifestation of total cerebral dysfunction, and a cranial CT examination was completed, which showed no hemorrhagic foci. After communicating with the family that the patient’s symptoms might be further aggravated, he was admitted to the hospital for the next step of diagnosis.
II. Treatment history
After the patient was admitted to the hospital, blood gas analysis tests were immediately completed to check for any serious acid-base imbalance. The results showed that all indicators of the patient’s blood gas analysis were within the normal range, and the oxygen saturation was 94%, which was at the critical value, so the patient was given oxygen and monitored for vital signs. The patient’s temperature was 36.8°C, blood pressure was 170/90 mmHg, heart rate was 85 beats/min, and respiration was 19 breaths/min. Palpation of the patient’s neck revealed a soft texture. The patient was unconscious, with signs of aphasia and disorientation, but the limbs were mobile and the muscle strength findings were poor. After the patient’s vital signs stabilized, he was given a complete cranial MRI, which showed a large diffusion restriction in the medial temporal lobe.
After full communication with the patient’s family, it was clear that the patient had a large cerebral infarction and the symptoms could easily worsen, and that the patient’s poor vascular status and obesity could cause the patient to be at risk. The patient was given cytarabine sodium injection to improve cerebral metabolism, wake-up call injection for cerebral protection, mannitol injection for dehydration, and edaravone injection for scavenging free radicals and lanchin injection for improving circulation.
III. Treatment effect
The patient’s vital signs were stable through 8 days of monitoring and medication treatment. However, because of the large area of cerebral infarction, the patient’s level of consciousness and pupil status were paid attention to during daily check-ups, and the patient was asked whether he had headache and dizziness, whether he had nausea and vomiting, and all new discomforts. In the first 3 days of hospitalization, the patient had obvious headache and dizziness, and after timely adjustment of the dosage of dehydration medication, the symptoms were significantly reduced. In the following days, the family indicated that they could communicate with the patient most of the time, so they were told to communicate with the patient diligently and always pay attention to the patient’s emotional performance. Fortunately, all the conditions of the patient were satisfactory, and the patient reached the discharge indication after 8 days of hospitalization, and the patient and his family were advised to rehabilitate as soon as possible.
IV. Notes
Thankfully, the patient’s symptoms improved after a series of treatments, but because the patient was unable to perceive his environment correctly and did not recognize the people he was familiar with in the past, and because the patient might have symptoms such as numbness and weakness of the limbs after discharge, he still needed the careful care of his family members after discharge, mainly in the following aspects.
1, family members should accompany the patient 24 hours a day in the early post-discharge period and should not ignore the patient.
2, because patients have swallowing difficulties, choking and coughing, so in the daily medication or eating, should pay attention to a small number of times, drinking water should not be too fast, if there is an inability to swallow or choking and coughing obvious, you can consider going to the hospital to place a gastric tube to prevent accidental aspiration.
3. After discharge from the hospital, patients are still prone to mental symptoms, such as hitting and cursing, and their temper may recur, so family members need to pay extra attention in daily life to prevent accidents.
V. Personal insight
Patients with large cerebral infarction in the medial temporal lobe may have mental disorders, visual field defects, limb numbness and weakness, aphasia, and hallucinations, which seriously affect the quality of life of patients. If the cerebrovascular status is poor and the infarct area expands, brain herniation may even easily occur and affect life by compressing the respiratory circulation center. In addition, the psychiatric symptoms of such diseases need to be differentiated from organic mental disorders, which need to be further clarified by perfecting cranial magnetic resonance examination.
The patient in this article came to the clinic precisely because of a series of psychiatric symptoms. Because of the patient’s age, it is easy to confuse the patient with other organic mental disorders, so the attending physician needs to have strong judgment and needs to conduct a comprehensive examination of the patient, precisely because the examination is comprehensive, in order to clarify the patient’s condition earlier and actively carry out treatment, so as to achieve a better treatment effect.