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*For medical professionals to read and reference misdiagnosis, misdiagnosis, misdiagnosis, and mistreatment.
The time delay will not come back ~ "otolithiasis" is a household name, deeply rooted in the hearts of the people, with a high incidence rate, a high rate of visits, and a high recognition rate, and neurologists have basically grasped its main points.
, here are some special cases
.
Case sharing of misdiagnosis and mistreatment Case 1: Male, 10 years old, diagnosed with otolithiasis, can't go to school for half a year after the doctor's diagnosis and treatment? Positional vertigo, nausea, vomiting, and turning over were symptomatic.
In the initial hospital, it was suspected to be "otolithiasis", but the reduction effect was not good
.
Therefore, after asking the medical history and finding a history of headache, he was diagnosed as "vestibular migraine", and preventive treatment was given, but the effect was still not good
.
Later, he was admitted to the ward of Professor Jiang's hospital and found that the child "is neither otolithiasis nor vestibular migraine, but schizophrenia"
.
The more obvious feature is that the eyes are not nystagmus, but "rolling the eyes".
How did you ask them? At that time, my grandmother came with the child.
When I asked, I found out that his mother suffered from schizophrenia.
Every time the child had an attack, the child imitated it, which also caused the previous misjudgment
.
Therefore, medical history inquiries are very important
.
Fortunately, in the end, the child returned to normal after antipsychotic treatment
.
Case 2: A 40-year-old female, who was first diagnosed with "otolithiasis" and treated for one month, then diagnosed with "vestibular migraine" and treated for another month, resulting in 2 months of leave? The woman was a doctor, and it turned out that she could not be promoted due to unsatisfactory attendance
.
Case 3: Female, 30 years old, first day of treatment, vestibular function test, report nystagmus +, "otolithiasis", treatment "reduction"; treatment on the second day, vestibular function test, report nystagmus-, treatment "reduction" Consolidation; visit the doctor on the third day, check the vestibular function, report nystagmus+, "otolithiasis" recurrence, treat "reduction"; visit the doctor on the fourth day, check the vestibular function, report nystagmus-, treat "reduction" consolidation; fifth Days of treatment, vestibular function test, report nystagmus -, and then treat "reset" consolidation
.
Five consecutive days of repositioning treatment made the patient very anxious, and when he heard the "repositioning" treatment, he was so frightened that he couldn't walk.
We couldn't help but ask, is this really "otolithiasis"? In the end, it was found that it was indeed not "otolithiasis", but "vestibular migraine".
After drug treatment, he returned to normal life
.
Through these three cases, we want to ask, we all know the diagnostic criteria and guidelines, why this still occurs, in fact, because of the disconnection between diagnosis and treatment
.
Professor Jiang Zidong also mentioned such a phenomenon
.
Even if it is not a neurologist, nor is it an otolaryngologist, even an ophthalmologist or a doctor in other departments will see "otolithiasis", and when they see positional vertigo, they will pay for a technician to reset the instrument, saying: "90% The effect is good, 10% of the effect is not good, go home and take medicine for rehabilitation training
.
”
In fact, the patient may have a "vestibular migraine"
.
High misdiagnosis rate in primary hospitals Of course, the identification of "otolithiasis" and "vestibular migraine" is not only in primary hospitals, but also in top hospitals
.
However, according to a recent report by the University of Zurich, among 951 patients referred from the grassroots level, 25.
1% (<65 years old) and 37.
6% (≥65 years old) were finally diagnosed with otolithiasis in tertiary hospitals.
The proportion is 20.
2%
.
Primary doctors diagnosed otolithiasis accounted for 12.
7% (<65 years old), 20.
7% (≥65 years old), vestibular migraine accounted for 1.
8%, the latter disease diagnosis rate was significantly lower
.
It is suggested that primary doctors have limited professional knowledge and diagnostic ability for vestibular migraine and otolithiasis, and should popularize and strengthen training
.
The reason for this is mainly because vestibular migraine is characterized by a variety of clinical manifestations and signs.
Some patients with migraine and vestibular symptoms are not synchronized, and about 30% of patients with vestibular migraine will have isolated episodes.
Vertigo/dizziness and nystagmus can easily be confused with some atypical otolithiasis
.
At present, some patients who were diagnosed as intractable otolithiae after repeated reduction and treatment failed clinically were finally found to be vestibular migraine
.
In view of this situation, domestic and foreign diagnosis and treatment standards emphasize the need for careful identification of the two
.
In recent years, research in the field of vestibular science at home and abroad has made rapid progress.
Only by fully grasping the constantly updated knowledge points can we correctly understand and implement the new diagnostic criteria and new practice guidelines for related diseases.
Accurate identification of otolithiasis and vestibular migraine
.
A clearer definition can effectively help in the differential diagnosis.
Previous definitions: In the past, habitual thinking believed that vertigo was a feature of peripheral vestibular disease, and dizziness was mostly related to central or psychogenic diseases, which led patients with vestibular disease to focus on ear and nose diseases.
Admissions and referrals between Laryngology and Neurology
.
●Dizziness is defined as the human body orientation dysfunction, vertigo is defined as the patient's own or external environment spinning sensation
.
●Dizziness is a general term for vertigo, pre-syncope, light headedness, and disequilibrium.
Dizziness includes vertigo
.
New definition: In the International Classification of Vestibular Symptoms issued by the Barany Association, the complex symptoms of balance system dysfunction are divided into four categories: dizziness, vertigo, vestibule-visual symptoms and postural symptoms.
.
●Dizziness, defined as a feeling of impaired or dysfunctional spatial orientation, is an illusion of no movement
.
●Vertigo is defined as an illusion of movement, a feeling of self-movement, including rotation or non-rotation, in the absence of self-movement
.
●Dizziness and vertigo are no longer subordinate but isostatic symptoms, and dizziness and vertigo may occur simultaneously in the course of the patient's disease
.
Each in turn contains tiggered and spontancous and two subcategories
.
Therefore, when a patient experiences dizziness induced by a change in position, it may be vestibular migraine or otolithiasis
.
In the 2015 version of the diagnostic criteria for otolithiasis, patients may not only experience dizziness, but also dizziness.
Patients with otolithiasis manifested by positional dizziness should be avoided from being missed
.
Familiarity with the clinical manifestations of vestibular migraine is the key to differential diagnosis.
When some patients with otolithiasis and vestibular migraine have similar clinical manifestations, which makes the differential diagnosis difficult, the diversity of clinical manifestations of vestibular migraine is the key to differential diagnosis
.
The vestibular symptoms of otolithiasis are monolithic and the characteristic dizziness/vertigo refers to transient dizziness/vertigo induced by head movement to a new fixed position
.
The vestibular symptoms of vestibular migraine are diverse, and the main symptoms include: (1) spontaneous dizziness/vertigo, including internal vertigo (illusion of self-movement) and external vertigo (visual rotation or feeling of floating in the surrounding environment); (2) ) Position-induced dizziness/vertigo; (3) Visually-evoked dizziness/vertigo, induced by complex or large motor visual stimuli; (4) Head-movement-induced dizziness/vertigo, which occurs when the head is moving, the patient Head movement intolerance occurs; (5) Head movement induces dizziness with nausea, which is characterized by perception of impaired spatial orientation
.
We can find that vestibular symptoms of vestibular migraine include not only dizziness and vertigo, but also spontaneous symptoms and induced symptoms
.
Written at the end In addition, in October 2021, Professor Jiang Zidong published an article in the "Chinese Medical Journal" - "Especial attention should be paid to the identification of benign paroxysmal positional vertigo and vestibular migraine", the identification of the two diseases Doctors who are not familiar with it can pay attention
.
Professor Jiang Zidong said that he hoped that under the framework of the International Classification of Vestibular Diseases, the majority of doctors should follow the nystagmus examination and classification newly promulgated by the Barany Association; screen the two diseases according to the new diagnostic criteria; make up for the specialization of the disciplines.
One-sided understanding; improve the diagnosis and treatment of vestibular diseases, including these two diseases, in order to reduce misdiagnosis and mistreatment
.
This article is compiled from the wonderful lecture given by Professor Jiang Zidong of Peking Union Medical College Hospital at the 2021 Cerebrovascular Disease Beijing Forum - "Discussing Otolithiasis Repositioning Skills and Discrimination of Vestibular Migraine"
.
"Heart-Leading "God" Gathering - Annual Inventory of Neurology in 2021" [Preview] On January 15, 2022, the "Heart-Leading "God" Gathering - Annual Inventory of Neurology in 2021" organized by the "Medical World" media came strongly.
Xi, Professor Wang Yongjun served as the chairman, and Academician Lu Lin led the sharing.
The experts from Shennei jointly took stock of the latest research progress in 2021, covering 8 disease areas such as cerebrovascular disease, AD, PD, epilepsy, and neuroimmunity, delivering the strongest voice in the neurological field.
To create a new academic fashion, to end the neurological research at home and abroad in 2021, and look forward to a new chapter in the field of neurological research in 2022
.
Scan the QR code of the poster below to join the group to get the viewing link↓↓↓
The time delay will not come back ~ "otolithiasis" is a household name, deeply rooted in the hearts of the people, with a high incidence rate, a high rate of visits, and a high recognition rate, and neurologists have basically grasped its main points.
, here are some special cases
.
Case sharing of misdiagnosis and mistreatment Case 1: Male, 10 years old, diagnosed with otolithiasis, can't go to school for half a year after the doctor's diagnosis and treatment? Positional vertigo, nausea, vomiting, and turning over were symptomatic.
In the initial hospital, it was suspected to be "otolithiasis", but the reduction effect was not good
.
Therefore, after asking the medical history and finding a history of headache, he was diagnosed as "vestibular migraine", and preventive treatment was given, but the effect was still not good
.
Later, he was admitted to the ward of Professor Jiang's hospital and found that the child "is neither otolithiasis nor vestibular migraine, but schizophrenia"
.
The more obvious feature is that the eyes are not nystagmus, but "rolling the eyes".
How did you ask them? At that time, my grandmother came with the child.
When I asked, I found out that his mother suffered from schizophrenia.
Every time the child had an attack, the child imitated it, which also caused the previous misjudgment
.
Therefore, medical history inquiries are very important
.
Fortunately, in the end, the child returned to normal after antipsychotic treatment
.
Case 2: A 40-year-old female, who was first diagnosed with "otolithiasis" and treated for one month, then diagnosed with "vestibular migraine" and treated for another month, resulting in 2 months of leave? The woman was a doctor, and it turned out that she could not be promoted due to unsatisfactory attendance
.
Case 3: Female, 30 years old, first day of treatment, vestibular function test, report nystagmus +, "otolithiasis", treatment "reduction"; treatment on the second day, vestibular function test, report nystagmus-, treatment "reduction" Consolidation; visit the doctor on the third day, check the vestibular function, report nystagmus+, "otolithiasis" recurrence, treat "reduction"; visit the doctor on the fourth day, check the vestibular function, report nystagmus-, treat "reduction" consolidation; fifth Days of treatment, vestibular function test, report nystagmus -, and then treat "reset" consolidation
.
Five consecutive days of repositioning treatment made the patient very anxious, and when he heard the "repositioning" treatment, he was so frightened that he couldn't walk.
We couldn't help but ask, is this really "otolithiasis"? In the end, it was found that it was indeed not "otolithiasis", but "vestibular migraine".
After drug treatment, he returned to normal life
.
Through these three cases, we want to ask, we all know the diagnostic criteria and guidelines, why this still occurs, in fact, because of the disconnection between diagnosis and treatment
.
Professor Jiang Zidong also mentioned such a phenomenon
.
Even if it is not a neurologist, nor is it an otolaryngologist, even an ophthalmologist or a doctor in other departments will see "otolithiasis", and when they see positional vertigo, they will pay for a technician to reset the instrument, saying: "90% The effect is good, 10% of the effect is not good, go home and take medicine for rehabilitation training
.
”
In fact, the patient may have a "vestibular migraine"
.
High misdiagnosis rate in primary hospitals Of course, the identification of "otolithiasis" and "vestibular migraine" is not only in primary hospitals, but also in top hospitals
.
However, according to a recent report by the University of Zurich, among 951 patients referred from the grassroots level, 25.
1% (<65 years old) and 37.
6% (≥65 years old) were finally diagnosed with otolithiasis in tertiary hospitals.
The proportion is 20.
2%
.
Primary doctors diagnosed otolithiasis accounted for 12.
7% (<65 years old), 20.
7% (≥65 years old), vestibular migraine accounted for 1.
8%, the latter disease diagnosis rate was significantly lower
.
It is suggested that primary doctors have limited professional knowledge and diagnostic ability for vestibular migraine and otolithiasis, and should popularize and strengthen training
.
The reason for this is mainly because vestibular migraine is characterized by a variety of clinical manifestations and signs.
Some patients with migraine and vestibular symptoms are not synchronized, and about 30% of patients with vestibular migraine will have isolated episodes.
Vertigo/dizziness and nystagmus can easily be confused with some atypical otolithiasis
.
At present, some patients who were diagnosed as intractable otolithiae after repeated reduction and treatment failed clinically were finally found to be vestibular migraine
.
In view of this situation, domestic and foreign diagnosis and treatment standards emphasize the need for careful identification of the two
.
In recent years, research in the field of vestibular science at home and abroad has made rapid progress.
Only by fully grasping the constantly updated knowledge points can we correctly understand and implement the new diagnostic criteria and new practice guidelines for related diseases.
Accurate identification of otolithiasis and vestibular migraine
.
A clearer definition can effectively help in the differential diagnosis.
Previous definitions: In the past, habitual thinking believed that vertigo was a feature of peripheral vestibular disease, and dizziness was mostly related to central or psychogenic diseases, which led patients with vestibular disease to focus on ear and nose diseases.
Admissions and referrals between Laryngology and Neurology
.
●Dizziness is defined as the human body orientation dysfunction, vertigo is defined as the patient's own or external environment spinning sensation
.
●Dizziness is a general term for vertigo, pre-syncope, light headedness, and disequilibrium.
Dizziness includes vertigo
.
New definition: In the International Classification of Vestibular Symptoms issued by the Barany Association, the complex symptoms of balance system dysfunction are divided into four categories: dizziness, vertigo, vestibule-visual symptoms and postural symptoms.
.
●Dizziness, defined as a feeling of impaired or dysfunctional spatial orientation, is an illusion of no movement
.
●Vertigo is defined as an illusion of movement, a feeling of self-movement, including rotation or non-rotation, in the absence of self-movement
.
●Dizziness and vertigo are no longer subordinate but isostatic symptoms, and dizziness and vertigo may occur simultaneously in the course of the patient's disease
.
Each in turn contains tiggered and spontancous and two subcategories
.
Therefore, when a patient experiences dizziness induced by a change in position, it may be vestibular migraine or otolithiasis
.
In the 2015 version of the diagnostic criteria for otolithiasis, patients may not only experience dizziness, but also dizziness.
Patients with otolithiasis manifested by positional dizziness should be avoided from being missed
.
Familiarity with the clinical manifestations of vestibular migraine is the key to differential diagnosis.
When some patients with otolithiasis and vestibular migraine have similar clinical manifestations, which makes the differential diagnosis difficult, the diversity of clinical manifestations of vestibular migraine is the key to differential diagnosis
.
The vestibular symptoms of otolithiasis are monolithic and the characteristic dizziness/vertigo refers to transient dizziness/vertigo induced by head movement to a new fixed position
.
The vestibular symptoms of vestibular migraine are diverse, and the main symptoms include: (1) spontaneous dizziness/vertigo, including internal vertigo (illusion of self-movement) and external vertigo (visual rotation or feeling of floating in the surrounding environment); (2) ) Position-induced dizziness/vertigo; (3) Visually-evoked dizziness/vertigo, induced by complex or large motor visual stimuli; (4) Head-movement-induced dizziness/vertigo, which occurs when the head is moving, the patient Head movement intolerance occurs; (5) Head movement induces dizziness with nausea, which is characterized by perception of impaired spatial orientation
.
We can find that vestibular symptoms of vestibular migraine include not only dizziness and vertigo, but also spontaneous symptoms and induced symptoms
.
Written at the end In addition, in October 2021, Professor Jiang Zidong published an article in the "Chinese Medical Journal" - "Especial attention should be paid to the identification of benign paroxysmal positional vertigo and vestibular migraine", the identification of the two diseases Doctors who are not familiar with it can pay attention
.
Professor Jiang Zidong said that he hoped that under the framework of the International Classification of Vestibular Diseases, the majority of doctors should follow the nystagmus examination and classification newly promulgated by the Barany Association; screen the two diseases according to the new diagnostic criteria; make up for the specialization of the disciplines.
One-sided understanding; improve the diagnosis and treatment of vestibular diseases, including these two diseases, in order to reduce misdiagnosis and mistreatment
.
This article is compiled from the wonderful lecture given by Professor Jiang Zidong of Peking Union Medical College Hospital at the 2021 Cerebrovascular Disease Beijing Forum - "Discussing Otolithiasis Repositioning Skills and Discrimination of Vestibular Migraine"
.
"Heart-Leading "God" Gathering - Annual Inventory of Neurology in 2021" [Preview] On January 15, 2022, the "Heart-Leading "God" Gathering - Annual Inventory of Neurology in 2021" organized by the "Medical World" media came strongly.
Xi, Professor Wang Yongjun served as the chairman, and Academician Lu Lin led the sharing.
The experts from Shennei jointly took stock of the latest research progress in 2021, covering 8 disease areas such as cerebrovascular disease, AD, PD, epilepsy, and neuroimmunity, delivering the strongest voice in the neurological field.
To create a new academic fashion, to end the neurological research at home and abroad in 2021, and look forward to a new chapter in the field of neurological research in 2022
.
Scan the QR code of the poster below to join the group to get the viewing link↓↓↓
