2016年 · 第96卷第05期

Headache and dizziness are common clinical symptoms, which can be single symptoms or may appear in the form of symptom clusters in patients' complaints. Studies have reported that 21% of dizzy patients have symptoms of headache, and 21% of headache patients have descriptions of dizziness. Vision, vestibular sensation and proprioception together maintain the balance of the body and are related to the vestibular pathway, while headache is related to the pain pathway. Therefore, patients with both headache and dizziness are not only the intersection of clinical symptoms, but also related to the interaction between multiple related neural pathways in pathogenesis, involving neurology, otolaryngology, internal medicine, emergency department, psychiatric psychology, imaging department, etc. When vestibular migraine appears in clinical diagnosis as an independent disease concept, many doctors find it both familiar and unfamiliar. In 1917, Boenheim first proposed the concept of vestibular migraine. Since then, patients with both headache and dizziness have been diagnosed with vestibular migraine, migraine-related vertigo, migraine vertigo, or migraine vestibulopathy. In 2012, the International Headache Society and the International Dizziness Society jointly developed and published the diagnostic criteria for vestibular migraine^[1]At the same time, it was included in the appendix of the third edition of the International Classification of Headache Diseases (ICHD-Ⅲ beta) in 2013^[2]。 In recent years, a large number of studies and explorations have sketched the outline of vestibular migraine in terms of concept, pathogenesis, clinical manifestations, signs, laboratory tests, diagnostic criteria and differential diagnosis, treatment and prevention of related diseases. Paying attention to this disease will help to improve the diagnosis and treatment of headache and dizziness-related diseases, avoid generalization, and avoid creating vestibular migraine as another conceptual trash can.

A 35-year-old female began to have shortness of breath, cough and expectoration after activity in January 2013 (more than 7 months of pregnancy at this time), which was white foamy sputum without blood in sputum, and intermittent edema of the face and both lower limbs. Cesarean section was performed on March 23, 2013. The postoperative symptoms were not significantly relieved, and the cough was worse than before. On April 3, 2013, he was admitted to the Department of Cardiology of Xiangya Hospital of Central South University due to "shortness of breath for 3 months after activity". Physical examination: body temperature 36.4℃, heart rate 81 beats/min, blood pressure 110/68 mmHg (1 mm Hg =0.133 kPa), multiple needle-like bleeding spots on both arms, coarse breathing sounds in both lungs, a few wet rales, uniform heart rhythm and P2 hyperactivity. WBC 3.9×10⁹/L, red blood cells 3.86×10¹²/L, platelets 319×10⁹/L. Liver and kidney function was normal. Cardiac color ultrasound: cardiac function ejection fraction (EF) 33%, stroke volume (SV) 50 ml, cardiac output (CO) 3.40 L/min (Simpson). The whole heart was enlarged, the right heart chamber was more obvious, the pulmonary artery and its branches were obviously widened, and the inner diameter of the ascending aorta was normal. Color Doppler flow diagram (CDFI): aortic blood flow Vmax 0.69 m/s, pulmonary blood flow Vmax 0.49 m/s, blue regurgitation beam reaching the middle of the atrium during mitral and tricuspid systole, Vmax 2.47 and 2.85 m/s, respectively; The pulmonary systolic pressure was estimated to be approximately 42 mmHg based on the maximum tricuspid regurgitation velocity. Conclusion Whole heart enlargement, moderate mitral and tricuspid valve regurgitation, pulmonary hypertension (moderate), moderate decrease in left ventricular systolic function and normal diastolic function. The systolic, diastolic and mean arterial pressures of the main pulmonary arteries were 64, 33 and 47 mmHg, respectively. Right ventricular systolic, diastolic and mean arterial pressures were 65, 9 and 12 mmHg, respectively. Conclusion: Pulmonary artery pressure, right ventricular pressure, pulmonary arteriolar resistance and whole pulmonary resistance were increased. Comprehensive analysis showed that the clinical diagnosis was "perinatal cardiomyopathy". After about 1 week of treatment with nifedipine to reduce blood pressure, anti-heart failure and prevent thrombosis, the patient's symptoms did not improve significantly.

A 30-year-old female was admitted to the hospital due to "involuntary motion of lips and limbs for 2 years, aggravated for more than 3 months". The patient had involuntary movement of lips and limbs without obvious inducement 2 years ago, which was obvious when he was awake and disappeared after falling asleep; Three months ago, the patient's symptoms worsened, he bit his lower lip, pushed the food out when eating, and had slurred speech with unstable walking. The local hospital diagnosed "dystonia? Obsessive-compulsive disorder?", and after treatment with "clonazepam" and "paroxetine", the improvement was poor, so he went to the Second Affiliated Hospital of Zhejiang University School of Medicine for treatment. Since the onset of the disease, the patient has lost about 10 kg of body weight. History of denial of toxic exposure. Parents are married by close relatives (cousins), and there is one brother who is healthy. Physical examination: emaciated body type, negative corneal K-F ring, thinning and ulceration of lower lip, partial defect, salivation (Figure 1), involuntary perioral movement, poor oral speech, still relevant answers, weakened bilateral pharyngeal reflex, reduced muscle tone of limbs, muscle strength grade 5, involuntary movement of limbs, stable and accurate finger-nose test, positive counterattack sign of both upper limbs, positive pull-back test, poor coordination during walking, weakened bilateral biceps tendon reflex, undrawn residual tendon reflex, and negative bilateral pathological signs.

A 55-year-old female was admitted to the hospital on 5 March 2007 due to persistent pain in the right lower abdomen for 3 months. Physical examination: body temperature 36.8 ℃, 20 breaths/min, 80 pulses/min, blood pressure 141/86 mmHg (1 mmHg =0.133 kPa). There is no cyanosis of the lips and no distension of the jugular veins. The appearance of the thorax was normal, and the breathing sounds of both lungs were clear. The heart rate was 80 beats/min, and the heart rhythm was uniform. Tenderness in the right lower abdomen, with a palpable mass about 3 cm ×4 cm in size. Past history: In December 2006, the patient underwent hysterectomy and right ovariectomy for uterine leiomyoma and right ovarian cyst.

Pelvic organ prolapse (POP) is a common disease that seriously affects middle-aged and elderly women. The causes of its pathogenesis are complex, and genetic factors have been paid more and more attention in recent years. Based on the methods of genome-wide association study, linkage analysis and case-control candidate gene association study, especially for susceptible populations, to explore the influence pathways of genetic factors in POP induction, it has been found that collagen-related genes (COL1A1、COL3A1), elastin-related gene (LAMC1), extracellular matrix-related genes (LOX、MMPs、TIMPs), estrogen related genes (ER α、ER β) and other gene loci are associated with the occurrence of POP. It is now reviewed as follows.

Acute coronary syndrome (ACS) is a common acute and severe cardiovascular disease. Previous studies suggest that the incidence of abnormal glucose metabolism after admission in ACS patients is at a high level, and suggest that admission hyperglycemia (AH) has an adverse effect on the prognosis of patients. However, there are still controversies regarding the related prognosis and treatment options. This article aims to review the study of ACS patients complicated with AH.