title: [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 middle cerebral arterial stenosis. He refused surgical treatment for social reasons but was given conservative therapy for the prevention of the recurrence of cerebral infarction. Immediately after he retired, he had severe recurrent cerebral infarction with severe anemia and low blood pressure due to gastroduodenal ulcer bleeding. It was inferred from MRI findings that this recurrent cerebral infarction was related to a hemodynamic mechanism and mental stress due to the gastroduodenal ulcer. The influence of occupational mental stress has been reported to be a risk factor of gastroduodenal ulcer. The occupational situation of a patient should be an important factor in consideration of the prevention of cerebral apoplexy.
authors.affiliation: Department of Neurosurgery, and Shiraniwa Hospital.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Aoyama
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Ohta
authors.forename: Saburou
authors.initials: S
authors.lastname: Sakaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nishizawa
mesh_terms: D000740:Anemia / Q000209:etiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008016:Life Change Events; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D016272:Occupational Health; D012307:Risk Factors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013276:Stomach Ulcer / Q000209:etiology*; D013315:Stress, Psychological / Q000150:complications*; D016312:Treatment Refusal; D017132:Workplace / Q000523:psychology*