一位男性病人58 歲，每天喝酒兩瓶，抽菸每天一包長達40 年。他在家中被發現意識混亂，講話沒有條理，警覺性變差，手部動作怪異，於是送至地區醫院就診，但沒有改善，轉送到本院急診。臨床診斷及理學檢查有意識混亂，頸部僵硬，上腹部疼痛，心室早期收縮。頭部斷層掃描顯示左側殼核(left putaminal intracerebral hemorrhage) 腦出血，血液進入腦室。住院過程有三大醫療問題，包括高血壓引起的腦內出血、酒精戒斷症候群和交通性水腦症 (communicating hydrocephalus)。文獻顯示，長期飲酒容易引起高血壓，且這類高血壓引起的腦內出血，較常發生在殼核處，本案例是典型的長期飲酒病人發生腦內出血、酒精戒斷症候及水腦症的案例，住院期間藥師建議醫師重新評估thiamine 針劑的使用，最後病人於住院第20 天出院。為了幫助病人恢復健康，應考慮藉由藥物、家屬陪伴及輔導病人戒酒、戒菸，並要控制高血壓。

A 58 years old male patient, used to drink two bottles of wine and smoke one package of cigarette everyday for 40 years. He was found that conscious disturbance at home, disorganized speech with decreased alertness and strange hand movement were noted before admission. He was treated in a local hospital initially but in vain, then he was sent to our emergency room (ER). In ER, physical examination showed confusion consciousness, neck stiffness, epigastric pain, and ventricular premature beat (VPB). Brain computerized tomography (CT) revealed left putaminal intracerebral hemorrhage (ICH) with rupture into ventricle.Through the period in the hospital, he had three medical problems including hypertension-induced ICH,alcohol withdrawal syndrome and communicating hydrocephalus. According to literature reparts, long-term consumption of alcohol may induce hypertension and secondary ICH. Putamen is the most affected area in this kind of ICH. This patient was a typical case of intracerebral hemorrhage, alcohol withdrawal syndrome and hydrocephalus in long-term drinking patients. During the hospital ization neurosurgeon accepted phaimacist’s suggestion to re-evaluate the use of intravenous thiamine. Patient discharged on the 20th day. In order to help patient recovery, advise patient to inhibit wine-drinking, smoking cessation and drug therapy, familial companionship and health education of pharmacist should be considered.