The pitfall in conservative therapy for working patients with brain ischemia

Abstract

A 59-year-old employed man was recommended to have surgical treatment for symptomatic left middlecerebral arterial stenosis. He refused surgical treatment for social reasons but was given conservative therapy forthe prevention of the recurrence of cerebral infarction. Immediately after he retired, he had severe recurrent cerebralinfarction with severe anemia and low blood pressure due to gastroduodenal ulcer bleeding. It was inferred fromMRI findings that this recurrent cerebral infarction was related to a hemodynamic mechanism and mental stressdue to the gastroduodenal ulcer. The influence of occupational mental stress has been reported to be a risk factor ofgastroduodenal ulcer. The occupational situation of a patient should be an important factor in consideration of theprevention of cerebral apoplexy.