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Abstract: The patient, a 58-year-old female, recently had recurrent dizziness with a lightheadedness like a boat ride. Recently, she had been bringing up her children at her daughter’s house and had not been resting well at night, and at first thought that the dizziness was caused by poor rest, but later continued to be dizzy without relief before drawing the attention of her family. He went to the hospital to improve the examination, suggesting lacunar cerebral infarction, and his condition was stabilized after medication was given. Lacunar cerebral infarction is usually due to infarction caused by small vascular lesions in the brain, and microhemorrhage may also exist.
Basic information】Female, 58 years old
Disease Type】Lacunar cerebral infarction
Hospital】Shandong Provincial Third Hospital
Date of consultation】May 2022
Treatment plan】Medication (butylphthalide soft capsule, cytarabine sodium capsule, hemosiderin soft capsule, resulvastatin calcium tablet, betahistine mesylate tablet)
Treatment Period】Outpatient treatment, follow-up after 1 month
Treatment effect】Stable condition, no special discomfort
I. Initial consultation
The patient came to the outpatient clinic with her daughter. She reported that she had been experiencing dizziness recently, and at first she thought it was caused by straining with the children. Neurological examination: positive finger-nose test, suggesting that the patient had ataxia; muscle strength and tone of the limbs were normal. Intracerebral examination was recommended to evaluate the brain and cerebrovascular condition. The patient and his family expressed understanding and actively cooperated with the examination. The cranial MRI suggested that the patient had lacunar cerebral infarction, and the SWI sequence suggested multiple microhemorrhage foci in the brain, which clarified the outpatient diagnosis and was considered to be caused by small vascular lesions and combined with multiple microhemorrhages in the brain.
II. Treatment history
The patient currently has recurrent dizziness persisting without relief, accompanied by nausea, desire to vomit, and unstable walking and easy falling. Combined with the cranial MRI, lacunar cerebral infarction was considered, but the SWI sequence was accompanied by multiple microhemorrhage foci in the brain, which was considered to be caused by the formation of lacunar foci due to the ischemic necrosis of brain cells caused by the occlusion of tiny intracerebral arteries, hyaline degeneration or deep penetrating branches. Due to the multiple microhemorrhagic foci in the brain, it is not recommended to take aspirin enteric soluble tablets, which may lead to the risk of hemorrhage. The patient was given butorphanol soft capsule, cytarabine sodium capsule, hemosiderin soft capsule, and rasulvastatin calcium tablets to improve brain circulation, nourish brain cell stability, and prevent atherosclerosis treatment. Betahistine mesylate tablets were also given to stop dizziness, while telephone follow-up of medication administration was arranged.
III. Treatment effect
Lacunar cerebral infarction is diagnosed by imaging, and the lesions are mostly found in the basal ganglia region of the cerebral hemispheres, which can manifest clinically asymptomatic. The patient had symptoms of dizziness related to chronic blood supply deficiency in the brain, and was given betahistine mesylate tablets to stop dizziness, cytarabine sodium capsules to nourish peripheral nerves, and hemosiderin soft capsules to improve circulation. The patient took the medication, and the dizziness symptom was significantly reduced on the second day of telephone follow-up, and the dizziness was significantly improved on the third day of telephone follow-up, and the patient could walk in a straight line. 1 month later, the patient went to the hospital for a review, and the blood pressure was stable, the dizziness was relieved, and there was no special discomfort, and the condition became stable.
IV. Notes
We are glad that the patient’s dizziness was relieved after treatment. We should pay attention to lacunar cerebral infarction with symptoms because lacunar cerebral infarction and cerebral microhemorrhage are both small blood vessel diseases in the brain, and about 60% of lacunar cerebral infarction may be accompanied by intracerebral microhemorrhage. In patients with multiple microhemorrhages in the brain, antiplatelet aggregation drugs such as aspirin enteric coated tablets are prohibited. During the treatment period, patients should actively monitor blood pressure, blood glucose, lipids and other high-risk factors to avoid aggravation of lacunar cerebral infarction, which eventually leads to large cerebral infarction. Usually, they should pay attention to whether there are symptoms such as dizziness, slurred speech, inability to move hands and feet, memory loss, etc. If these symptoms occur, they should actively go to the hospital for review to rule out the possibility of aggravation of cerebral infarction. Patients should pay attention to the presence of petechiae on the limbs and subcutaneous bleeding during the medication period, and if they appear, they should go to the hospital to draw blood for coagulation function tests and routine blood tests. In general, patients should develop a good lifestyle, quit smoking and drinking, avoid staying up late and straining, take a light and easy-to-digest diet as the mainstay, and exercise daily to increase physical strength.
V. Personal insight
Some of lacunar cerebral infarcts are asymptomatic lacunar cerebral infarcts with small infarct area, and generally do not require special treatment in non-important functional areas. However, some of them belong to symptomatic lacunar cerebral infarction, which requires further exclusion of the possibility of other cerebrovascular lesions, and the patient in this case presented with symptoms such as dizziness and unstable walking due to lacunar cerebral infarction with multiple microhemorrhagic foci in the brain. Therefore, it is important to pay attention to the disease and prevent it in order to have a good health. When encountering patients with symptomatic lacunar cerebral infarction, more attention should be paid to actively rule out the presence of intracerebral microhemorrhages, or cerebrovascular atherosclerosis, to avoid the possibility of missing the diagnosis.