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Abstract: The patient came to our hospital with sudden onset of persistent vertigo and vomiting, and was found to have unaccompanied tinnitus, hearing loss and other neurological symptoms. The initial diagnosis was probably vestibular neuritis, which required perfect cranial magnetic resonance to exclude central lesions, and hearing and vestibular function tests to clarify the diagnosis. The patient obtained a better prognosis through comprehensive treatment with drugs and vestibular rehabilitation.
Basic information】Male, 49 years old
Disease Type】Acute vestibular syndrome
Hospital】Qilu Hospital of Shandong University
Time of consultation】November 2017
Treatment plan】Medication (injectable sodium methylprednisolone succinate + Ginkgo biloba extract injection + methylcobalamin injection + betahistine mesylate tablets) + vestibular rehabilitation training
Treatment Period】7 days of inpatient treatment, 1 month of outpatient review
Effectiveness】Dizziness disappeared and unsteadiness in walking improved
I. Initial consultation
The patient suddenly developed vertigo, spinning sensation, nausea and vomiting 5 days ago, and the spinning sensation was reduced after infusion at the local hospital. On examination, the patient was found to have rightward horizontal spontaneous nystagmus and leftward skewed walking; hearing examination showed normal low and middle frequencies in both ears, moderate to severe sensorineural deafness in high frequencies, A-shaped curve of acoustic conduction resistance in both ears, diminished response on the left side of the cold and heat test, and reduced gain in the left horizontal and upper semicircular canals on the passive head toss test and sweeping waves were seen. The patient was diagnosed with left vestibular neuritis combined with pituitary tumor.
II. Treatment history
We explained to the patient and his family that the symptoms of vertigo and unsteadiness in walking were caused by damage to the left vestibular nerve and were generally not life-threatening, and instructed the patient to relax and ensure sleep; the treatment plan was infusion therapy with injectable sodium methylprednisolone succinate, Ginkgo biloba extract injection and methylcobalamin injection, plus oral betahistine mesylate tablets, and encouraged the patient to get out of bed as soon as possible and perform vestibular rehabilitation training; reassured The patient and family members were nervous about pituitary tumor and explained that this vertigo was not caused by pituitary tumor and that pituitary tumor is asymptomatic at present and can be reviewed regularly.
III. Treatment effect
The patient’s vertigo was significantly relieved after the comprehensive treatment of inpatient medication and vestibular rehabilitation training, and there was no nausea or vomiting. After 7 days of hospitalization, the patient was discharged from the hospital and was advised to continue oral medication treatment, daily vestibular rehabilitation training, and encouraged to participate in ball games such as badminton and table tennis, and to come back to the hospital for review in 1 month. 1 month later, the patient reported that the vertigo disappeared, no significant unsteadiness in walking, and resumed normal life and work rhythm.
IV. Notes
We are glad that the patient has recovered effectively after medication and rehabilitation training. However, it is recommended that the patient should relax, sleep and live regularly in daily life after discharge, and perform daily vestibular rehabilitation training and ball games such as badminton and table tennis to promote vestibular recovery; in view of the fact that vestibular function and balance have not been fully recovered, avoid high-risk behaviors such as driving, cycling and working at height until the condition is completely improved; during the period of continuing oral medication, if tinnitus, hearing loss and other neurological symptoms occur, seek prompt medical treatment. If tinnitus, hearing loss, and other neurological symptoms occur during oral medication treatment, seek medical treatment in a timely manner.
V. Personal insight
If patients with acute vestibular syndrome do not receive timely and effective clinical intervention during the acute phase, the disease may be prolonged. Therefore, if the organism has recurrent nausea, vomiting and vertigo, it should go to the hospital promptly. It is necessary to exclude the central pathology and to conduct hearing and vestibular function examination to help the diagnosis. After the diagnosis is clear, the patient should be calmed down and relaxed, ensure sleep, limit the use of vestibular inhibitors, and start individualized vestibular rehabilitation as early as possible. Usually, as in this patient, the condition can improve significantly with the combination of medication and vestibular rehabilitation.