Emergency department came a repeated vertigo patient, the cause can not be leaked

Vertigo is one of the most common symptoms in neurology in general hospitalsThis case of patients long-term vertigo, after turning over appears, repeated in my hospital, to give oral drugs and static rehydration treatment, has been poor resultsFinally, in the neurology ward hospital treatment, finally clear the cause, after treatment, dizziness improvedthe introduction of the diseasepatients before March without obvious triggers appear repeated vertigo, to turn over obvious, accompanied by nausea and vomiting, vomit for white, yellow, coffee-colored liquid, less; Patients in the outpatient treatment, when the doctor considered for benign syndrome vertigo, to give oral ampicillin, pystestatin, fluoroguerreine and other drug treatment, patient dizziness does not ease1 week before admission to hospital, the patient felt dizzy aggravated, after turning over, especially in the middle of the night, when falling asleep, after turning over appeared vertigo, nausea and vomiting and other symptoms, so that they did not dare to fall asleep again, so in my hospital emergency treatmentauxiliary examinationblood pressure 170/100mmHg during emergency treatment, blood routine and blood biochemistry is basically normalhead CTThe cavity cavity stove on both sides of the base section is softened with the left-hand inflatorbrain changes in old agee-cardiogramsinus heart rhythmpatients to give the reverse clock to transposition, to give static drops of active blood, improve brain metabolism and other drug treatment for 3 days, slightly improved the condition1 day before admission to hospital, when the patient turned over in the middle of the night, the patient turned over appeared dizzy aggravated, accompanied by nausea and vomiting, vomit for the stomach contents, the amount of more, chest tightness panic, red face red, cold sweat, when blood pressure 170/99mmHg, then to my hospital emergency treatmentIn order to seek further treatment, the emergency department proposed "vertigo syndrome, hypertension" admitted to the hospitalNo headache, no limb weakness, no limb numbness, no physical image, no immediate black, unconscious loss, fearless cold, fever, no cough, cough sputum, no abdominal pain, diarrhea and other symptoms▎ past historyhas a history of hypertension for 10 years, the most high blood pressure 190/100mmHg, the current oral drug control blood pressure, blood pressure control instability, systolic blood pressure 150-170mmHg; Years, oral drug control, blood glucose control instability, fasting blood sugar 5-10mmol/L, post-meal blood sugar 10-12mmol/L;▎ head CT flat sweepskull CT flat sweep: the cavity cavity stove on both sides of the base section with the left plate stove softenedAfter▎ was admitted to the hospital, thethe patient was clear, the speech was clear, and the body was examined with itDouble pupils and other large equidistant circles, diameter 0.25cm, the presence of light reflection, no abnormality of the eye, no eye shock, facial needle pain no reduction, two-sided forehead symmetry, two sides of the nasal lip groove symmetry, tongue center, pharynx reflection (plus), right upper limb muscle force 2 levels, right lower limb muscle force 4 level, leftmuscle tension highmutual relief examination: two-sided nose test, and knee-to-knee test are stable, rotation test is normalThe right limb needle is reduced, the tendon reflexes of the limbs are reflected , the double-sided strokes, the papyress (-)Chassa, Crostos, B.C(-)Dix Hallpike test (-) diagnosis ideas patients repeatedly vertigo for months, turned over easily appear, and with nausea and vomiting symptoms, and high blood pressure, red face, chest tightness panic, cold sweat, lasting several minutes Neurology is mainly the symptom of the sequelae of the past brain infarction, imaging on the skull CT see base section softening the stove Therefore, consider the following diagnosis: 1) benign syndrome vertigo: the patient has a certain relationship with the body position, turnover obviously, and with nausea and vomiting, the duration is not long, in line with transient, repetitive, rigid, seizure and so on, so first consider the disease However, no eye tremors were seen in the eyes of the neurologic body, and the Dix Hallpike test (-) required further examination 2) hypertension caused by: patients with long-term hypertension, blood pressure fluctuations, each time a dizzy attack, high blood pressure is obvious, the highest hypertension 180/100mmHg, and the patient's blood pressure fluctuations, patients younger, whether there is secondary hypertension, further examination clear 3) post-circulative cerebral infarction: patients have high blood pressure, diabetes and other basic diseases, and 3 years ago patients have cavity cerebral infarction, this repeated dizziness, can not be completely excluded, further improve the head MRI and other examinations ▎ the next day, the head MRI came out, Liu dark flower ingen
▎ the third day, the head of the brain MRI enhancement ▎ ▎ diagnosis is: fourth ventricular tumor fourth ventricular tumor has a certain activity, especially with ti tumor or cyst, when the position or head position changes suddenly blocked the fourth ventricle, and acute obstruction of the brain, causing recallthed the patient's main complaint: in the middle of the night when the patient turned over, when the dizziness aggravated, accompanied by nausea and vomiting, vomit for the stomach contents, the amount of more, accompanied by chest tightness panic, red ness, cold sweat, each dizziness is related to turning over no wonder!!! finally, the patient's neurosurgery line fourth ventricular tumor removal, pathology is clearly the veinplex papilloma After surgery, the patient did not appear in the body position alt-vertigo Experience: first: Medical history is important!!! Patients and their families repeatedly mentioned that dizziness is related to turning over, and after turning over in the middle of the night, they will wake up so that they are afraid to fall asleep again Later encounter this patient, the heart must have this string the second: CT has its limitations, especially for the lesions of the later cranial nest, so highly suspect edillion lesions, must check the magnetic resonance clear Li Tuming Source: