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 groggy feeling; headache accompanies it, relatively mild and location indefinite, sometimes in the upper part of the back of the head, sometimes in the wind pool acupoint, sometimes in the solar plexus, occasionally in the, 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 (until 3 or 4 a.m.). Medical history: In 1993 and 2002, short-term (about 10 days) episodes of headache and dizziness occurred, located in the upper part of the back of the head, wind pool acupoint, or solar plexus, accompanied by temporary nausea. EEG and other examinations were normal, and recovery was achieved after taking Vitamin B1 and oryzanol. In March of this year, an episode occurred similar to previous ones, but it resolved untreated (as the cervical spondylosis was believed to be the cause).
Onset time: The condition began in early September and was mild enough to avoid seeking medical attention. Symptoms worsened from September 26 to 27, and a follow-up visit was made to the local hospital on September 28. Currently, symptoms are mild.
Laboratory test results: Blood pressure was 140/90. Doppler and EEG examinations were conducted:
- Doppler results: "S2 > S1 peak in vertebral basilar artery suggests vertebral basilar artery spasm."
- EEG results:
- Basic rhythm: Moderate to low amplitude 8-14C/S α wave rhythm observed in all leads, with irregular waveform adjustment, poor amplitude modulation.
- Fast waves: Small amounts of low amplitude 15-18C/S β waves mixed in both sides of all leads.
- Slow waves: More moderate amplitude 5-7C/S θ waves mixed in both sides of all leads.
- Waveform characteristics: Low leads with moderate amplitude, symmetrical on both sides.
- Pathological waves: More moderate amplitude 5-7C/S θ oscillations observed in all leads, symmetrical on both sides.
- Catalytic tests: Light 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 over a week, followed by a cough for another week).
On the 29th, further lumbar puncture and a complete blood test were conducted, with results as follows:
- Cerebrospinal fluid: Appearance was colorless and translucent; glucose measured 3.6; chloride measured 112; protein 0.49; white blood cell count 0.
- Complete blood test (24 items): Except for absolute eosinophil count 0.02 and percentage of eosinophils 0.4 being higher than normal, 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 been effective, and current symptoms are mild, especially at night, with tolerance to working until the end of the day.
A head and neck MRI will be conducted at the local hospital next Monday.
Doctor's answer:
Your condition cannot be diagnosed at the moment, and there are several possible reasons for this. First, cervical spondylosis may be involved, which can compress the vertebral artery, leading to vasospasm and insufficient blood supply to the brain, resulting in symptoms. Second, blood pressure should be measured, as overwork and stress often cause hypertension, which can lead to cerebral vasospasm and ischemia-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 prodromal 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.