Patient's question:
Headache and dizziness (mostly accompanied by discomfort in the neck). The main sensation of dizziness is a lack of clarity in the mind, slow response, and a feeling of being sluggish; headaches accompany it, are relatively mild and location-indeterminate, sometimes in the upper part of the back of the head, sometimes in the GB20 (wind pool acupoint), sometimes in the SI (sun acupoint), and sometimes in the BL1 (mingming acupoint), or in two or three places. Additionally, eyes feel sticky, similar to the sensation of light sensitivity and a desire to tear after staring at a computer for a long time.In the past month, work pressure has been high, with one-third of the time experiencing neurasthenia (lasting until 3 or 4 a.m.). Medical history: In 1993 and 2002, short-term (about 10 days) episodes of headache and dizziness occurred, localized to the upper part of the back of the head, GB20, or SI, accompanied by temporary nausea. EEG and other examinations were normal, and recovery followed the intake of vitamin B1 and oryzanol. In March of this year, an episode occurred with symptoms similar to previous ones, but it resolved untreated (as the person believed it was caused by cervical spondylosis).
Onset time: The condition began in early September, with mild symptoms that did not require medical attention. Symptoms worsened from September 26 to 27, and on September 28, the person returned for a follow-up visit at a local hospital. Currently, symptoms are mild.
Laboratory test results: Blood pressure was 140/90. Doppler and EEG examinations were conducted:
- Doppler results: "S2 > S1 peak in basilar artery suggests basilar artery spasm."
- EEG results:
- Basic rhythm: All leads show medium-low amplitude 8-14C/S α wave rhythm, with irregular waveform adjustment, poor amplitude modulation.
- Fast waves: Both sides show a small amount of low-amplitude 15-18C/S β waves mixed with slow waves.
- Slow waves: Both sides show a moderate amount of low-amplitude 5-7C/S θ waves.
- Waveform characteristics: Low leads with medium amplitude, symmetric on both sides.
- Pathological waves: Both sides show a moderate amount of 5-7C/S θ oscillations, symmetric on both sides.
- Evoked potentials: Light flash suppression (-); hyperventilation (-).
- Topography: θ band power value 4.2.
EEG diagnosis: Significant abnormalities, leading to a doctor's diagnosis of suspected encephalitis (due to a cold in late August that lasted for over a week, followed by a cough for another week). On the 29th, further lumbar puncture and a complete blood test were performed, with results as follows:
- Cerebrospinal fluid: Appearance: colorless, translucent; glucose: 3.6; chloride: 112; protein: 0.49; white blood cell count: 0.
- Complete blood test (24 items): Except for absolute eosinophils (0.02) and percentage of eosinophils (0.4), which were slightly elevated, all other results were within the normal range.
After the examination, intravenous infusion (betahistine and ginkgo biloba) was administered for 4 days with no significant improvement. In the past week, taking vitamin B1 and oryzanol has shown some effectiveness. Currently, symptoms are mild, with the worst at night, but the person can tolerate working until the end of the day.
A follow-up magnetic resonance imaging (MRI) of the head and neck is planned for next Monday at the local hospital.
Doctor's answer:
Your condition cannot be diagnosed at the moment, and there are several possible reasons for this. First, cervical spondylosis may be the cause, leading to compression of the vertebral artery, resulting in vasospasm and insufficient blood supply to the brain, which brings about symptoms. Second, blood pressure should be measured, as overwork and stress often lead to hypertension, causing cerebral vasospasm and ischemia and hypoxia. Third, there may be a dysfunction in the regulation of blood vessels and nerves, commonly known as vasomotor headaches. This condition tends to recur, with premonitory symptoms such as visual disturbances, vision impairment, and dizziness. The pain in the starts intensely and then spreads, lasting for a long duration with severe intensity.