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Abstract: A 70-year-old female presented with recurrent lateral limb weakness 1 week ago, which was completely relieved after about 15 minutes. At that time, the family did not pay attention to it and thought it was related to old age. 3 days ago, the patient developed weakness of the lateral limbs, which persisted without remission, and was rushed to the hospital, where the perfect cranial magnetic resonance examination suggested cerebral infarction. after clear diagnosis, medication + rehabilitation was given, and the patient’s condition was stabilized and symptoms were relieved through systematic and active treatment.
Basic information】Female, 70 years old
Disease Type】Cerebral infarction, hemiparesis
Hospital】Shandong Provincial Third Hospital
Consultation time】February 2021
Treatment plan】Medication (aspirin enteric dissolved tablets, atorvastatin calcium tablets, ginkgo biloba extract injection, edaravone injection, monosialic acid tetrahexose ganglioside sodium salt injection) + rehabilitation (passive movement of unilateral upper and lower limbs during the acute period; active muscle strength training after discharge)
[Treatment period] 12 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】Stable condition and improvement of symptoms
I. Initial consultation
On the second day of the Lunar New Year, the patient’s family brought the patient to the hospital. The family described: 1 week ago, there was recurrent weakness of the limbs, but it was completely relieved after 15 minutes of rest. Three days ago, the patient experienced persistent limb weakness, which has not improved until now, so the patient was brought to the hospital. Outpatient neurological examination: right limb muscle strength grade 2, positive pathological signs. Outpatient diagnosis: acute cerebrovascular disease, hemiparesis. The patient was recommended to be hospitalized to improve the intracerebral examination and clarify the intracerebral lesion. The family expressed understanding and actively cooperated with the examination.
II. Treatment history
After admission, the patient was routinely examined, including routine blood tests, liver and kidney functions, ion, lipids, blood glucose, glycosylated hemoglobin, and cardiac enzymes, which indicated high lipids, blood glucose, and blood uric acid. Cranial magnetic resonance suggested acute cerebral infarction and cerebral arteriosclerosis. Electrocardiogram chest X-ray did not show any significant abnormality. After admission, aspirin enteric dissolved tablets and atorvastatin calcium tablets were given orally, and Ginkgo biloba extract injection, edaravone injection and monosialic acid tetrahexose ganglioside sodium salt injection were used to improve circulation antiplatelet and aggregation of nutrient brain cells. As the patient was diagnosed late in the early stage and cerebral infarction had already formed, only internal conservative treatment can be given at present, and rehabilitation work for limb function as well as fine motor was given at a later stage according to the limb assessment. Passive movement of the upper and lower limbs unilaterally during the acute phase; active muscle strength training was performed after discharge. After 12 days of hospitalization, the patient improved and was discharged from the hospital. He was asked to actively control blood pressure, blood lipids and blood sugar and adhere to long-term rehabilitation training.
III. Treatment effect
The patient’s condition was stable after 3 days of treatment, and the limb strength was improved to about level 3, and the limb strength assessment was level 3+ at the time of discharge. One month later, the patient and his family members came to the outpatient clinic for follow-up, and the patient reported that the symptoms of unilateral limb numbness had disappeared and the muscle strength of the affected limb had improved through rehabilitation exercises. The patient was advised that six months after the formation of cerebral infarction is an effective rehabilitation period, which needs to be persistently carried out, and the patient and his family expressed their willingness to adhere to long-term rehabilitation treatment.
IV. Notes
We are glad that the patient’s symptoms of hemiparesis have improved after treatment. Patients should actively monitor blood pressure, blood glucose and blood lipid during the treatment period, and review them every 1 month; if the control is not good, they should go to the hospital to regulate the drugs in time. Usually, they should pay attention to low salt and low fat diet, avoid high purine food, avoid spicy, stimulating and greasy food, quit smoking and alcohol, and avoid staying up late and straining. After discharge from the hospital, attention should be paid to the recovery of limb function. If there is a decrease in limb strength, slurred speech and aggravation of limb sensory disorder, it is not excluded that the cerebral infarction is aggravated, and a follow-up visit to the hospital is needed.
V. Personal insight
Hemiplegia is a sign caused by brain cell dysfunction due to intracerebral lesions. Causes of hemiplegia include: hypertension, atherosclerosis, hyperglycemic cerebral aneurysm, atrial fibrillation, etc. If the patient in this case had come to the clinic earlier, and had come to the clinic with recurrent limb immobility, the outcome of the patient’s treatment might have been different, so early prevention and treatment of hemiplegia is especially important. Scientific education on prevention and treatment of hemiplegia should be actively promoted, and doctors should emphasize the importance of prevention and treatment if they find patients with poor vascularity or multiple high-risk factors during the consultation process, and instruct them to follow up regularly at the hospital to help avoid aggravation of the disease.