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Abstract: Chronic vestibular syndrome is a vertigo symptom due to dysfunction of the vestibular function cochlea or central nervous system, which leads to vertigo. This patient is a 48-year-old middle-aged female who came to the clinic with recurrent vertigo in the past 3 years, which was not clearly diagnosed after examination at a local hospital and had poor treatment results. The patient was given a complete examination and a comprehensive diagnosis of chronic vestibular syndrome was made. She was given medication, and her symptoms improved completely, and she stopped taking the medication successfully.
Basic information】Female, 48 years old
Disease Type】Chronic vestibular syndrome
Hospital】Shandong Provincial Third Hospital
Date of consultation】December 2020
Treatment Plan】Oral medication (Escitalopram Oxalate Tablets, Ginkgo Biloba Extract Tablets, Betahistine Mesylate Tablets, Powerful Dazzling Tablets, Cytophosphatidylcholine Sodium Capsules)
Treatment period】Outpatient treatment, 1 week after outpatient follow-up, 1 month after telephone follow-up
Treatment effect] The clinical symptoms of dizziness and vertigo have completely improved.
I. Initial consultation
Patient Zhang, 48 years old, was walking wobbly when she came to the clinic. She reported that she had been experiencing dizziness repeatedly for 3 years, always feeling dizzy, like stepping on cotton, and walking unsteadily, which greatly affected her life. He had been treated at a local hospital with no clear diagnosis and had taken many drugs to stop dizziness, but the effect was effective at first, but later it was no longer obvious. At the same time, the patient did not sleep well at night and was very anxious. In order to seek further treatment, he came to our hospital.
We performed a neurological examination of the patient, which showed that the patient had a positive closed-eye difficulty in standing sign, but no other positive signs were evident. Based on the patient’s past medical history and clinical presentation, a preliminary diagnosis of chronic vestibular syndrome was made. The patient and his family expressed understanding and actively cooperated with the treatment.
The patient’s blood tests were completed in the outpatient clinic, including routine blood tests, liver and kidney function ion, lipids, blood glucose, cardiac enzymes, and glycated hemoglobin, etc. The results of the tests suggested that the patient had mild liver insufficiency and no other significant abnormalities were seen. The cranial MRI examination was completed, and the results showed that the patient had multiple lacunar infarcts in the brain and mild cerebral arteriosclerosis with cerebral atrophy. Vestibular function examination was performed on the patient, and the results suggested decreased bilateral horizontal semicircular canal function. The results of the foaming test were negative, and the patient had a normal EEG.
II. Treatment history
The above tests showed that the patient had cerebral atrophy, and cerebellar atrophy was more obvious, and vestibular function suggested low horizontal semicircular canal function, suggesting vestibular dysfunction, both of which led to the patient’s current symptoms.
Chronic vestibular syndrome is a chronic balance dysfunction disease caused by vestibular and cerebellar lesions, which usually has a long duration and recurrent symptoms with persistent exacerbation. The patient and his family were educated about the disease and reassured that the disease was not completely untreatable and that medication could improve the symptoms and even lead to a complete cure. After hearing this, the patient and his family put down their worries and expressed their full cooperation with the treatment.
The patient was given escitalopram oxalate tablets orally to control anxiety symptoms, ginkgo biloba extract tablets orally to improve circulation, and betahistine mesylate tablets and potent dizziness tablets to control dizziness symptoms. Cytarabine sodium capsule nourishes brain cells and improves brain metabolism for treatment.
III. Treatment effect
After 1 week of medication, the patient came for follow-up. Through communication with the patient, we learned that the patient had high compliance with the treatment. After 3 days of oral medication, he reported that his mood had improved, his dizziness had decreased, and he could walk alone. After taking the medication for 5 days, the dizziness symptoms basically improved and there was no other special discomfort. The patient’s clinical symptoms of dizziness and vertigo had completely improved by the date of review, and no significant abnormalities were found in the blood test results, so the drug was discontinued. 1 month later, the patient was followed up by telephone, and no special discomfort occurred after the drug was discontinued.
IV. Notes
We are glad that after active treatment, the patient’s clinical symptoms such as dizziness and vertigo have completely improved and no recurrence has occurred. However, patients need to pay attention to the following points in their daily life.
1. Since this disease is a chronic balance dysfunction disease, patients should pay attention to balance function rehabilitation training in daily life, such as walking in a straight line, etc., and also increase daily exercise appropriately, such as jogging, swimming, etc.
2, daily attention should be paid to ensure good sleep, avoid staying up late, strain, emotional excitement, etc., and avoid excessive eye use.
3. During the treatment period, patients should pay attention to whether the symptoms of dizziness and vertigo are aggravated at home, as well as whether the quality of sleep is improved, and also pay attention to whether the symptoms of unsteadiness in walking are improved. If the above-mentioned symptoms worsen, patients should follow up with the hospital outpatient clinic in a timely manner.
V. Personal insight
Chronic vestibular syndrome is a chronic disease with a long course, and the symptoms of dizziness can last for months or years, mostly with vertigo or dizziness and unsteadiness in walking as the main clinical symptoms.
For this type of patients, a comprehensive examination should be performed to determine whether there are any intracerebral lesions or vestibular disorders to avoid any missed diagnosis. In the present case, the patient was diagnosed and treated successfully after active examination and exclusion of other organic diseases, and her symptoms improved.