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Abstract: A 56-year-old uncle Li was recently admitted to the hospital by the emergency room because of dizziness, headache, vomiting, and unconscious convulsions. Through physical examination and blood pressure testing combined with cranial CT results, it was clearly identified as hypertensive cerebral hemorrhage. He was treated with nimodipine injection, mannitol injection, piracetam injection, amlodipine benzoate tablets and olmesartanate tablets. At the time of discharge, Uncle Li’s dizziness and headache, vomiting and convulsions disappeared, and his blood pressure returned to normal, and there was no recurrence at the outpatient follow-up.
Basic information】Male, 56 years old
Disease Type】Large blood vessel disease (hypertensive cerebral hemorrhage)
Hospital】Beijing Anzhen Hospital, Capital Medical University
Date of consultation】January 2022
Treatment plan】Medication (nimodipine injection, mannitol injection, piracetam injection, amlodipine benzoate tablets, olmesartanate tablets)
[Treatment period] 3 weeks of inpatient treatment, follow-up of discomfort
Treatment effect】Dizziness and headache, vomiting and convulsions disappeared, and blood pressure returned to normal
I. Initial consultation
The patient was admitted to the hospital by the emergency room because of dizziness, headache, vomiting and unconscious convulsions. The patient’s eyes were initially seen to be closed and unable to open, and a hemorrhagic foci in the right basal ganglia area were seen through cranial CT examination, and there was no aneurysm. As the bleeding did not reach the indication for surgery, the patient was transferred to internal medicine for treatment. The patient was known to have a 10-year history of dizziness and headache and hypertension up to 120/180 mmHg. He had been treated with captopril tablets and his symptoms had improved, so he stopped taking antihypertensive drugs since then. Recently, when dizziness and headache appeared again, she took Chinese herbal medicine, the specific drug is unknown, and her symptoms were reduced, so she stopped the treatment on her own. The patient had no past history of infectious diseases or poisoning, no hot flashes or night sweats, chest tightness or precordial discomfort, and no history of smoking or drinking. I found that Uncle Li had a normal body temperature by physical examination, but there was a slight neurological deficit. Blood pressure test revealed a blood pressure of 112/213 mmHg, and combined with the cranial CT results, a clear diagnosis of hypertensive cerebral hemorrhage was made.
II. Treatment history
Since the patient is currently in the acute phase of cerebral hemorrhage and has a small amount of bleeding, it is necessary to promptly lower the blood pressure to reduce the amount of bleeding, and monitor the blood pressure and heart rate by electrocardiogram, while using nimodipine injection to control the blood pressure. In addition to lowering blood pressure, the dehydrating drug mannitol injection was needed to lower intracranial pressure and relieve headache symptoms, and piracetam injection was used to restore damaged brain cells. blood pressure was measured to drop after 2 hours, indicating that the drug was more effective and maintenance treatment could be continued. The next day examination found that the blood pressure continued to fall and the bleeding volume did not increase, so the patient was instructed to take oral antihypertensive drugs amlodipine benzoate tablets and olmesartanate tablets, and to stop using mannitol injection and piracetam injection after 1 week. 3 weeks later, the patient was discharged with stable condition, but he needed to adhere to the antihypertensive drugs and discomfort follow-up.
Third, the treatment effect
The patient’s dizziness and headache were reduced and the unconscious convulsions disappeared. 3 weeks later, the blood pressure was stabilized within the normal range, the bleeding was partially absorbed on the cranial CT, the patient’s dizziness and headache disappeared, and other indicators were normal, so discharge was granted. After that, no dizziness, headache, vomiting, unconscious convulsions and other symptoms appeared again.
IV. Precautions
Because the patient was more cooperative with the treatment, the symptoms could be relieved sooner, and I was happy for the patient.
1, after discharge from the hospital also need to pay attention to avoid overexertion, maintain a calm mood, regular rest and reduce the triggers of elevated blood pressure.
2, it is recommended that Uncle Li adhere to the drug treatment, avoid unauthorized discontinuation of drugs, otherwise lead to the recurrence of dizziness, headache symptoms.
3, daily advice to achieve a low-salt and low-fat diet, the daily amount of salt control, avoid long-term large amounts of greasy and spicy stimulating food, so as not to affect the recovery of the disease.
V. Personal insight
Hypertensive cerebral hemorrhage often occurs when blood pressure is excessively elevated, which is generally dangerous and requires timely medical treatment to lower blood pressure to prevent further bleeding. As in the case of 56-year-old Uncle Li, the symptoms can be better relieved by applying antihypertensive drugs and drugs to lower intracranial pressure and restore damaged brain cells. For those who have hypertension, they should pay attention to take antihypertensive drugs regularly and monitor their blood pressure to avoid accidents such as hypertensive cerebral hemorrhage.