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Abstract: The patient had recurrent unilateral limb weakness for the past 3 days, along with large tongue and slurred speech, and was diagnosed with transient cerebral ischemic attack after hospital examination. Through active treatment with percutaneous endovascular stenting and medication, the patient’s condition was stabilized and the symptoms of unilateral limb weakness and slurred speech disappeared.
Basic information】Female, 55 years old
Type of disease】Transient ischemic attack
Hospital】Shandong Provincial Third Hospital
Date of Consultation】May 2021
Treatment plan] Percutaneous endovascular stenting + medication (Ginkgo biloba extract injection, edaravone injection, aspirin extended-release tablets)
Treatment period】Hospitalization for 12 days, outpatient follow-up after 1 month
Treatment effect] The patient’s condition was stable, and the symptoms of unilateral limb weakness and slurred speech disappeared.
I. Initial consultation
The patient, Sister Liu, had recurrent unilateral limb weakness and slurred speech three days before she came to the hospital. The patient reported that he had diabetes mellitus for many years and had recently had an irregular diet with high blood glucose; there were no obvious positive signs on neurological examination; the preliminary diagnosis of transient cerebral ischemic attack, combined with the past medical history, was that he needed to be alerted to the occurrence of cerebral infarction and was recommended to be hospitalized for further evaluation of the intracranial brain parenchyma and cerebrovascular condition.
II. Treatment history
Considering the high incidence of cerebrovascular events and the severity of cerebrovascular lesions, the patient agreed to percutaneous endovascular stenting to improve the blood supply to the brain and avoid cerebral infarction after communication with the patient and his family. The operation was relatively smooth, and the patient had no special discomfort, no symptoms such as lack of limb movement and slurred speech, and the treatment effect was good. Ginkgo biloba extract injection, edaravone injection and aspirin extended-release tablets were given after the operation.
III. Treatment effect
Transient ischemic attack is a transient temporary neurological dysfunction caused by intracranial vascular lesion. The patient had frequent symptoms such as slurred speech, inability to move, and partial body sensory disorder before treatment. After treatment, the patient’s related symptoms were relieved and the treatment effect was good. The patient’s previous symptoms of dyskinesia and slurred speech did not reappear, and there was no specific discomfort after the surgery. The patient was instructed to follow up with the clinic after 1 month to assess the recovery.
IV. Precautions
As a treating physician, we are very pleased that the patient’s condition has improved after treatment. However, the patient was reminded that he should pay attention to monitoring blood pressure, blood glucose, blood lipids, blood uric acid and other high-risk factors during treatment and take medication on time. Once there are signs of neurological dysfunction such as limb immobility, slurred speech, partial body sensory impairment, and urinary and fecal incontinence, it should be taken seriously and relevant intracerebral examinations should be improved for early intervention. Patients should develop good lifestyle habits, quit smoking and drinking, eat a low-salt, low-fat diet, avoid staying up late and straining, and have regular checkups. Patients should actively cooperate with treatment, avoid the occurrence of falls, and avoid strenuous physical exercise. After discharge from the hospital, patients should regularly visit the neurology department for follow-up examinations, such as cranial magnetic resonance, carotid ultrasound and other related examinations, to assess the treatment with medication. The patient should be observed for the recurrence of symptoms of slurred speech and limb immobility.
V. Personal insight
Transient cerebral ischemic attack may cause misunderstanding to patients that they do not need treatment because their symptoms are better, in fact, on the contrary, this disease needs urgent treatment, once cerebral infarction occurs, it means irreversible ischemic necrosis of brain cells and permanent neurological dysfunction signs will appear, so early intervention treatment can achieve better treatment effect. Especially for families with elderly people, family members should pay more attention to observe that if the elderly people have symptoms such as slurred speech and lateral limb impairment but recover quickly, they should be alerted to transient cerebral ischemic attack and should be actively sent to the hospital for evaluation and treatment to avoid delaying the disease.