Which lesion should pay for persistent unrelieved dizziness?

*For medical professionals only, if you want to solve the mystery, you must first understand the conduction pathway of the vestibular nerve

Summary of medical records

A 54-year-old woman with a history of previous diabetes was admitted to the hospital on May 17, 2022 with the main complaint of "dizziness for 19 hours, aggravated for 2 hours", accompanied by nausea and vomiting, no rotation of vision, blurred vision, no tinnitus, hearing loss, no difficulty swallowing, drinking water and cough
.

Physical examination:

Bilateral pupils and other large isocircles, sensitive light reflex, bilateral horizontal nystagmus, tongue extension, limb muscle strength V-class, bilateral finger-nose test and left lower limb and knee tibial test is stable, right lower limb and knee tibial test is slightly less stable, no abnormal sensation, negative bilateral pathological signs
.

On the day of admission, no new infarction was found in the head MRIs, and the diagnosis and treatment was based on peripheral dizziness, and the symptoms of dizziness on the next day continued to be unrelieved, and walking was unstable, and DWI (magnetic sequence) negative cerebral infarction was not excluded
.

The treatment was adjusted to aspirin enteric-coated tablets + clopidogrel tablets for double anti-platelet aggregation, eureclin needles and burephthalide softgels to improve collateral circulation, edaraven dexanderol injection to scaveng free radicals, rosuvastatin calcium tablets lipid-lowering and stabilization spots, etc
.

Figure 1 2022.

The dizziness of patients following up outside the hospital has not been alleviated for more than 2 months, which of the many infarction foci should be paid for? To solve this mystery, we must first understand the conduction pathway
of the vestibular nerve.

Sum up

Lesions that cause dizziness/vertigo are cerebellar worms, knots, pompoms, the lower level of the pontine, and the lateral dorsal and bridge arms
of the medulla oblongata.

Let's go back and look at the skull MRI in this case, whether it is clear at a glance, and the places marked in the following figure are the responsible lesions
we are looking for.


Figure 9 2022.
5.
21 Cranial MRI (cerebellar tonsils from left to right, pompom-level bridge arm)
Reference source:

Li He,Wu Shengxian,Tang Wei.
Neurolocalization diagnosis[M].
Fujian Science and Technology Press.
2021

Where to look for more clinical knowledge of neurology?
Come to the "Doctor's Station" and take a look 👇

Source of this articleMedical Neurology ChannelGuo YanjiaoThis article reviewLi Tuming, Deputy Chief Physician Responsible EditorMr.

Copyright noticeThis
article is original, reproduced please contact the authorization-End-submitted/reprinted/business cooperation, please contact: yxjsjbx@yxj.
org.
cn*The medical community strives to be accurate and reliable when the published content is approved, but does not make any commitment and guarantee for the timeliness of the published content, as well as the accuracy and completeness of the cited information (if any), etc.
, and does not assume that the content is outdated, Any liability arising from the possible inaccuracy or incompleteness of the referenced materials
.

Relevant parties are invited to verify separately when adopting or using this as a basis for decision-making
.