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Abstract: The patient, Mr. Zhang, had a fight with someone at the vegetable market and suddenly felt weak in his right leg and did not speak fluently on the way home. The patient felt bad and immediately signaled his family to call 120. the patient was diagnosed with cerebral hemorrhage by the doctor’s CT examination, and was admitted to the neurosurgery department for emergency craniotomy for hematoma removal. the operation went well, and the patient’s speech was fluent after the operation, and the muscle strength of the right limb was significantly restored.
Basic information】Male, 55 years old
Disease Type】Left basal ganglia cerebral hemorrhage, hypertensive disease
Hospital】Qingdao Traditional Chinese Medicine Hospital
Date of Consultation】November 2021
Treatment plan】Surgical treatment (craniotomy for hematoma removal)
Treatment Period】14 days in hospital
Treatment effect] Vital signs were stable, muscle strength of the right limb was better than before surgery, and speech was more fluent than before surgery.
I. Initial consultation
The patient was rushed to our hospital. The family said that the patient had a verbal argument with someone while shopping for groceries, after which he developed symptoms such as weakness of the right leg and lack of fluent speech. The patient’s symptoms were carefully examined: he fell into a coma, the left pupil was large, and cerebral hemorrhage was considered. The patient was then immediately given a CT of the head and an urgent blood test, and then together with the family, the patient was pushed to the CT room for a CT of the head. the examination results suggested that the patient had a typical large hematoma in the left basal ganglia region with a hematoma volume of about 50 ml, a midline shift, and brain herniation. Based on the patient’s symptoms, physical examination and ancillary tests, the preliminary diagnosis was established: cerebral hemorrhage in the left basal ganglia region and hypertensive disease.
II. Treatment history
After communicating with the family regarding the patient’s condition and treatment plan, the patient agreed to the surgery, and the operating room was immediately notified. The operating room began preoperative preparation, and the emergency nurses started skin preparation. At this time, the patient’s emergency blood test results were also available, and there were no obvious contraindications to surgery, so the patient was advanced to the operating room.
Based on the patient’s specific situation, the decision was made to choose craniotomy for hematoma removal. After opening the skull the patient’s brain tissue was under high tension, so a non-functional area was selected for minimally invasive operation to remove about 50 ml of hematoma, followed by careful hemostasis and installation of 1 drainage tube. The operation was relatively smooth, and the patient woke up after the operation and entered the ward to continue the follow-up treatment.
III. Treatment results
After the operation, the patient’s hematoma was cleared and the organism gradually recovered. Fourteen days after surgery, the patient’s vital signs were stable, the muscle strength of the right limb increased, and the speech ability improved, so discharge was granted. Fourteen days after discharge, the patient’s surgical incision was healing well, with no redness, swelling, or hard nodes, and her hair was slowly growing out. The muscle strength of the right limb was significantly better than before surgery, reaching grade 4 (grade 0 before surgery), and she could move around on crutches; her language was significantly better than before surgery, and she could communicate briefly. The patient’s blood pressure was also well controlled, and her mood was cheerful and full of hope for her future life.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but in daily life the patient needs to pay attention to the following matters.
1, should avoid some high oil and high fat food, and according to personal preference to moderate some exercise, can reduce the body lipid content, reduce cholesterol, enhance the quality of blood vessels, so as to improve the quality of survival.
2, smoking and alcohol consumption are high-risk factors for the occurrence of such diseases, especially smoking can make the blood vessels constrict and become less elastic, which increases the possibility of developing the disease. Patients should also have regular follow-ups and regular monitoring of blood pressure, blood glucose and lipids.
V. Personal insight
The patient’s blood pressure rose sharply after the quarrel, which broke the capacity of the blood vessels in the brain and led to the rupture of the blood vessels, causing a large amount of blood flow to the brain parenchyma, which destroyed the brain tissue and damaged the speech and motor areas, resulting in symptoms such as lack of fluency in speech and lack of movement of the right limb. In this case, daily attention should be paid to controlling blood pressure, including avoiding arbitrary adjustment of antihypertensive drugs and not believing in prescriptions for hypertension.