In the neurology clinic at Beijing Xuanwu Hospital, if an elderly patient comes in for dizziness, the clinician will often ask, “Have you had a recent vascular ultrasound? If not, doctors often recommend that patients have this test first. Min Baoquan, deputy chief physician of the Department of Neurology at Beijing Xuanwu Hospital, told reporters that this is to rule out the possibility of a stroke (including cerebral infarction and cerebral hemorrhage). Dizziness is common in people over 60 years old. There are many causes of dizziness, and the most common cause is insufficient blood supply to the brain due to cerebral atherosclerosis. The cause of dizziness can be determined by whether it is associated with a change in position. If it is relieved when lying down and is evident when sitting up, it is strongly suggested to be related to cerebral insufficiency of blood supply. In most cases, most of these dizziness can be relieved after 1-2 weeks of symptomatic treatment (activation of blood circulation, vasodilation, etc.), but there are still some patients with unrelieved dizziness who will have a stroke. However, if the patient is younger than 60 years old, has been dizzy for a longer period of time (>2 weeks), and has no significant relief after treatment for cerebral insufficiency, the possibility of other causes should be considered (a separate article will be written on this). If the dizziness persists for more than a week in elderly people over 60 years of age and is not relieved by treatment, or if the dizziness is relatively mild at the beginning but worsens after treatment, and if there are risk factors such as obesity, smoking, alcohol abuse, hypertension, diabetes, hypotension and hyperlipidemia, such dizziness may be a precursor symptom of stroke or the possibility of cerebrovascular disease should be alerted, so the associated risks should be reviewed and evaluated and the Therefore, it is necessary to re-examine and evaluate the related risks and re-adjust the diagnosis and treatment strategy. Such an elderly person should go to the hospital for relevant tests to rule out the possibility of stroke early. Blood pressure and fluctuations need to be measured; general tests needed are blood biochemistry, lipids and blood viscosity, folic acid, homocysteine, carotid ultrasound (CA), transcranial Doppler (TCD), cranial CT arteriography (CTA), magnetic resonance angiography (MRA), etc., as a way to evaluate the possibility of stroke. If blood pressure, blood glucose, lipids and fibrinogen are well controlled, and if CA, TCD, CTA and MRA suggest significant stenosis or vascular malformation in the cerebral vessels, the doctor often recommends that the patient undergo cerebral angiography (DSA), and some may require stent placement or internal carotid artery endothelial debridement. If the cerebral stenosis is less than 50%, cerebral angiography is usually not necessary and conservative treatment (lipid-lowering, fibrinogen-lowering, etc.) is given depending on the situation. Dr. Min also recommends that all elderly people with dizziness symptoms, regardless of whether the dizziness lasts for a long or short time, should go to the hospital for vascular ultrasound and blood and other related examinations every 1-2 years if they are over 60 years old. 201304 Min Baoquan: There are patients who hate to go to review CA/TCD several times a year regardless of the severity of atherosclerosis, but in fact, it may not be necessary to have such an intensive examination. Many doctors have different opinions and dispositions regarding medication. The following are my personal suggestions and medication experience: 1. If CA, TCD, CTA, MRA indicate that there is only intimal thickening in the cerebral vessels and a small amount of light plaque in the arteries, CA/TCD should be rechecked in 2-5 years, and lipid-lowering and fibrinogen-lowering treatment can be given depending on the situation (if the related index is high). Aspirin is not necessary. 2. If CA, TCD, CTA, MRA indicate that the cerebral vessels only have obvious intimal thickening and more obvious plaque in the arteries, such as arterial stenosis of 30-60%, CA/TCD should be rechecked in 1-2 years, and fibrinogen-lowering therapy can be given depending on the situation. It is better to give lipid-lowering treatment (even if the lipid level is normal), depending on the situation aspirin or clopidogrel can be used (if there is already cerebral infarction, it is better to use). 3.If CA, TCD, CTA, MRA suggest more obvious plaque in the head and carotid artery, and let the artery stenosis reach 60% or more, it is recommended to review CA/TCD in 0.5-1 year, and CTA or MRA if necessary, you can give fibrinogen-lowering treatment (even if the blood index is not high), give lipid-lowering treatment (even if the blood lipid level is normal), and make sure to use anti-platelet drug aspirin or clopidogrel. The other medications will not be discussed. Other medications should be decided at the discretion of the doctor who will see the patient on a case-by-case basis. Of course, for people over 50 years of age, annual physical examinations are generally recommended, regardless of underlying medical conditions and physical fitness. In most cases, it is difficult to recover after a stroke, mainly because brain infarction or cerebral hemorrhage can cause different degrees of brain tissue necrosis, and this part of the necrotic brain tissue is certainly not regenerable, and the greater the necrosis, the more severe the hemiplegia, and the more difficult it is to recover. The partial recovery after stroke is mainly due to the compensatory effect of the half-dead brain tissue (semi-dark zone) around the necrotic foci after roughly recovering. Since it is difficult to recover after stroke, prevention of cerebrovascular disease is probably more important than treatment, that is, prevention is better than cure. Therefore, it is necessary for people with risk factors such as obesity, smoking, alcoholism, hypertension, diabetes, hypotension, wind heart disease and hyperlipidemia to improve their lifestyles, quit smoking and alcohol, and actively control hypertension, hyperglycemia urine and hyperlipidemia.