Didn't expect, cause low blood pressure is actually it!

There are many reasons for hypotension, such as: insufficient blood volume (blood loss, dehydration), infection, myocardial infarction, arrhythmia, heart pressure plug (fluid), anemia, hypothyroidism, hypotension and the application of hypotension drugs, etc, but then this lead to hypotension, let me never thinkmiddle-aged male, to "left limb weakness with speech confusion for 10 hours" as the main prosecution admitted to the hospital;10 hours ago patients without obvious causes of left limb weakness, the specific performance of the left upper limb lifting can not, left lower limb walking drag, accompanied by speech confusion, hearing comprehension normal;have a history of smoking and drinkingcheck: P:65 times/min, R:19 times/min, BP: 120/76mmHgMental lynx, poor spirit, speech is not clear, left eye outreach is not sufficient, the right eye is not fully received, visible horizontal eye shock, two-sided pupil and other large circle, sensitive to light reflection, two-sided forehead symmetry, left nasal lip groove shallow, left mouth sagging, tongue-stretching left, double-sided pharynx reflex, normal limb tension, left upper limb strength 3, left muscle muscle strength 3Two-sided Babinski sign (-), meninges stimulation sign (-)There were no obvious abnormalities in the residual nervous systemadmitted to the hospital to check the head CT prompt: cavity cerebral infarction; electrocardiogram: sinus heart rhythm, occasional lying earlyblood: BNP: 180ng/L, troponin T: 0.01 ng/ml; blood routine: white blood cells: .5 x 10 x 9/L, neutrophils absolute value: 9.99 x 10 x 9/L, lymphocytic absolute value: 1.4 x 10 x 9/L, acidophilic granulocytes absolute value: 0.21 x 10 l.lclotting function: clotting enzyme time (PT): 16.5 seconds, internationalstandardized ratio: 1.26, fibrinogen: 338mg/dl, D-dipoly: 29ng/mlsee this, considering cerebral infarction, and then given aspirin 100mg plus clopidogrel 75mg and atoflavatin 20mg applicationbut after 3 hours the patient's heart rate and blood pressure suddenly dropped, heart rate: 40 times / minute, blood pressure: 85/63 mmHg, so the analysis of why the patient suddenly heart rate and blood pressure drop? Combined with the patient's condition and auxiliary examination can rule out insufficient blood volume, infection, myocardial infarction, arrhythmia and antihypertensive drugs caused by the acute blood pressure drop, or first correct the patient shock bar, so give dopamine micro pump, 15 minutes later finally raised the blood pressure to 110/80mmHg, followed by the heart rate also came up, finally relievedwith dopamine continued pumping for more than 10 hours, observation of patient blood pressure is now still stable, thinking of dopamine stop it, but million did not expect is a stop of medicine, blood pressure down, very helpless, what is the reason?then went on to perfect the examination:chest CT: heart shadow and large vascular shadow did not see abnormalThe arterial mezzanine can be excludedheart color super: no obvious abnormality in the internal structure of the heartHeart pressure plugs caused by cardiac envelope fluid can be eliminatedfound this still did not find the reason, really can not think of what other causes can be ruled out, so perfect the head magnetic resonance to see the infarction site and area how, but the result is i never thought, please see:head MRI-MRA: brain stem acute stage cerebral infarction, base artery stenosisthen analysis of the results of this examination, whether there will be a relationship between the terrierAs can be seen from the film: the terrier is located in the brain stem, and close to the middle line of the site; then, when it comes to the brain stem, it has to say its anatomy, in the middle axis of the brain stem has a dispersion distribution of cells and fibers cross-arranged mesh region, known as the mesh structure, what is its function? There are many neuromodulation centers in the cerebral stem mesh structure (e.gcardiovascular exercise center, blood pressure reflex center, respiratory center, etc.)see this, do you have a sudden sense of cheerfulness? Yes, after excluding other causes, consider the heart rate and blood pressure drop due to damage to the brain stem mesh structurecontinue to give anti-platelets, improve circulation applications, over time, gradually reduce dopamine dosage, it is gratifying that the patient finally removed dopamine, the final blood pressure of 116/80mmHgauthor: MrMumu Source: