38-Year-Old Man Successfully Treated for Multifocal Cerebral Infarction Without Thrombolysis
In the medical field, timely and appropriate treatment is crucial for stroke patients. This case involves a 38-year-old male patient, Mr. Li, who was diagnosed with multifocal cerebral infarction after experiencing recurrent stroke-like symptoms. Despite refusing thrombolytic therapy due to time constraints and personal preference, he showed significant improvement through a comprehensive treatment plan combining medication, physical therapy, and traditional Chinese medicine (TCM). This article outlines his treatment journey and highlights alternative stroke management strategies.
Patient Profile and Diagnosis
Name: Mr. LiAge: 38Gender: MaleDiagnosis: Multifocal Cerebral InfarctionHospital: Baoding No.1 Chinese Medicine HospitalAdmission Date: February 2022
Treatment Plan Overview
Duration: 2 weeks inpatient, followed by 3 months outpatient rehabilitationTherapies Used:
- Medication: Aspirin enteric-coated tablets, Clopidogrel bisulfate tablets, high-dose Atorvastatin calcium tablets, Ginkgo diterpene lactone glucosamine injection, Butylphthalide sodium chloride injection, Ozagrel sodium injection
- Physical Therapy: Movement therapy, direct current stimulation
- Traditional Chinese Medicine (TCM): Acupuncture, auricular acupuncture, Thunder-fire moxibustion
Initial Presentation and Diagnosis
Mr. Li visited the hospital after waking up with right-sided limb weakness. He had a history of two previous strokes eight and two years prior, which resulted in left-sided motor impairment and speech difficulties. Brain MRI and MRA scans revealed acute infarction in the left basal ganglia and corona radiata, as well as multiple infarctions in the bilateral basal ganglia, corona radiata, and right thalamus. MRA also showed signs of cerebral atherosclerosis. Given his recurrent stroke history and imaging findings, he was diagnosed with multifocal cerebral infarction and admitted for treatment.
Therapeutic Approach
Since Mr. Li arrived at the hospital more than six hours after symptom onset—beyond the optimal window for thrombolysis—and declined clot-busting treatment, alternative interventions were initiated. Dual antiplatelet therapy with aspirin and clopidogrel was started to prevent further clot formation. High-dose atorvastatin was administered to combat atherosclerosis and stabilize plaque. Intravenous medications such as Ginkgo diterpene lactone glucosamine, Butylphthalide, and Ozagrel were used to improve cerebral metabolism, reduce oxidative stress, and enhance microcirculation.
Complementary Therapies
In addition to conventional treatment, Mr. Li received TCM interventions including acupuncture, ear acupuncture, and Thunder-fire moxibustion. Physical therapy, including movement therapy and direct current stimulation, was also integrated into his rehabilitation plan. Lifestyle modifications such as a low-salt, low-fat, and low-sugar diet were emphasized, along with active participation in rehabilitation exercises.
Recovery and Outcome
Over the course of two weeks, Mr. Li showed no signs of disease progression. His limb weakness improved significantly, allowing him to walk with a cane and assistance. He was discharged with instructions to continue outpatient follow-up, oral medications, acupuncture, and physical therapy. After three months of consistent treatment and rehabilitation, his motor function improved markedly.
Post-Treatment Care and Prevention
Although Mr. Li's condition improved, recurrent strokes can lead to serious complications such as motor disability, speech impairment, or cognitive decline. Patients must prioritize rest, maintain a healthy lifestyle, and avoid risk factors such as excessive salt, fat, sugar intake, fatigue, smoking, and alcohol consumption. These measures help reduce atherosclerosis risk and prevent future strokes.
Clinical Insights and Recommendations
This case highlights that even in the absence of traditional risk factors like hypertension, diabetes, or hyperlipidemia, young adults can still suffer from multifocal cerebral infarction. Early diagnosis and comprehensive treatment are essential to prevent life-threatening complications such as severe cerebral artery occlusion. Individuals with a history of stroke should remain vigilant for new or worsening symptoms and seek prompt medical attention. In some cases, neurosurgical interventions like bypass surgery may be necessary to improve cerebral blood flow and support long-term recovery.