Dizziness clinic diagnosis difficult, teach you "5 tricks" to avoid misdiagnosis and mistreatment

There is a complex relationship between dizziness/dizziness and etiology (Figure 1), and the main causes of dizziness/dizziness include peripheral, mental and centrality of the vestibularcentrality accounted for less than 10% of the cause, as part of the central dizziness / vertigo of the post-circulating ischemia patients, in the total dizziness / dizziness patients accounted for a smaller proportion, but at present in the neurology of a large number of dizziness / vertigo patients are randomly diagnosed as ischemic causesthe complex relationship between dizziness/dizziness and etiology
if you do not want to misdiagnose misdiagnosis, as a neurologist, first of all, remember this "5 tricks - 3 don't 2 to":do not easily diagnose patients as vertebral underlying artery blood supply deficiency (VBI
);do not pull neck vertebral hyperplasia and cavity cerebral infarction together with dizziness/dizziness;to carefully evaluate the value of cerebral arterial stenosis, especially vertebral underlying arterial stenosis in the diagnosis of dizziness/vertigo etiology;should recognize that transcranial Doppler ultrasound (TCD) is not a diagnosis of insufficient cerebral blood supplywhy is this "3 don't 2 to" it? This article takes you to an analysis1concept backward, concept confusionPCI only includes post-cycle transient cerebral ischemic attack (TIA) and post-cycle cerebral infarction, call edgy no longer used: VBIVBI and PCI there are many differences, as shown in Figure 2:Figure 2 VBI and PCI differences
2 misuse, abuse of TCD in neurology misuse and abuse of the detection method is tCD, and TCD in China's most serious mistake is also based on the change in blood flow rate to make a "brain blood shortage" diagnosis A significant proportion of the dizziness/dizziness patients who visited the clinic had TCD patients have often been suffering from dizziness/ dizziness for a long time, the first sentence to sit down at the clinic is "Doctor I am dizzy", the second sentence is "I have insufficient blood supply to the brain." Then from the bag out of the TCD diagnosis report, which often reads "the vertebral base artery blood supply is insufficient", with such a diagnosis report can not be allowed patients do not believe that they have insufficient blood supply the question: Can TCD diagnose a lack of blood supply to the brain? answer is: No! but the trouble is that many neurologists don't know that TCD can't diagnose blood supply deficiency in the brain, and seeing such a report suggests that TCD can diagnose blood supply deficiency in the brain more serious is: the operator who writes the brain blood supply is not enough TCD does not understand that TCD is not able to diagnose the brain blood supply deficiency, if you know, this technician will not be so diagnosed clinicians often see such TCD reports: (1) the rapid increase in blood flow suggests cerebral arterial spasms; slow blood flow suggests that the brain is not enough blood supply Why not? There are at least three concepts that blur: (1) the rate of blood flow in the arteries; figure 3 blood flow rate is not equivalent to blood flow through blood vessels: (1) blood flow rate , the distance of red blood cell flow (cm/s) ;(2) through blood vessels , volume of red blood cell flow (ml/s) per unit of time in the case of vascular diameter, the blood flow speed and blood flow is proportional: (1) the blood flow speed is fast - the blood flow is large; unknown vascular intercept area, the blood flow rate does not reflect blood flow Figure 4 Before and after the stent, the relationship between blood flow speed and area is completely different
is the flow of blood through the artery is reduced? In fact, because the blood flow through the blood vessels is not the same as the blood flow of the brain Blood flow in an artery does not represent the blood flow in the brain supply area, and the decline in brain blood flow can be found by the following examination: CT perfusion, MRI perfusion, SPECT, PET A decrease in blood flow within the artery does not necessarily indicate a decrease in blood flow in the artery supply area (Figure 5, figure 6) Figure 5 6 3 assume the relationship between certain abnormal examination results and dizziness /dizziness
1 cervical vertebral hyperplasia transferred from the field to the outpatient dizziness / vertigo patients, a considerable part of the cervical vertebral-X tablets, especially the elderly, cervical vertebral-X-x report often appeared on the diagnosis: cervical vertebral curvature, vertebral promorphiology, narrowing, vertebrae, etc These patients themselves will ask: "Doctor, my lack of blood supply is not caused by cervical vertebral disease?" "
in fact, cervical vertebral hyperplasia is rare and is not the main cause of dizziness/dizziness and post-circulatory ischemia (Figure 7) The relationship between cervical vertebral hyperplasia and dizziness/dizziness is not clear, at least not the cause of post-circulatory ischemia figure 7 2 in the outpatient look at dizziness / vertigo patients often encounter another phenomenon, the first sentence of the patient is "doctor I dizzy", the second sentence may be "I have a cerebral infarction" or "I have a cavity terrier", and then will be eager to take out the ct skull to the doctor to see The patient's meaning is very clear: my dizziness / dizziness is caused by the brain infarction, doctor you see how to treat my cavity terrier to treat my dizziness / dizziness an elderly person, it is not surprising that there are several small terrific or ischemic lesions on the head OFCT or MRI if one or more of the risk factors such as high blood pressure, hyperlipidemia, diabetes, or smoking are present the clinical manifestations of terrier are as follows, none of which says simply dizziness or dizziness! pure motor stroke; pure sensory stroke; disorderparapleparaplegia; sensory motor stroke; not full hand clumsiness syndrome 3 cerebral artery stenosis
Now more and more doctors know that vascular imaging is very important, and many patients do vascular imaging, then cerebral arterial stenosis can explain the patient's dizziness/ dizziness? It is easy to go into another mistake, relying too much on auxiliary examination, while neglecting to consult! summary of the full text: read to understand why is "3 don't 2 to" Finally repeat: do not easily diagnose the patient as VBI do not easily diagnose the patient as PCI or ischemic dizziness / dizziness do not cervical vertebral hyperplasia and cavity cerebral infarction and dizziness / dizziness Pull together carefully assess the value of cerebral arterial stenosis, especially vertebral and underlying arterial stenosis in the diagnosis of dizziness/vertigo causes
recognize that TCD is not a diagnosis of insufficient blood supply in the brain
author: Du Zhigang Source: medical neurology channel