almaz
18.08.2004, 18:29
32 years, the woman.
Complaints-
Constant headaches (all head, especially a nape, a forehead, orbits), little bit decreasing by the evening (when darkens in the street), a giddiness (is more correct - feeling as though you will lose consciousness), at height of intensifying of a pain pereodicheski a nausea (the vomiting was 1 time during acupuncture in occasion of head + fields of vision), intensifying be ill or sick at job with a computer, viewing of the TV, a phone conversation, job with the bent head, a sharpness of vision (though there is a myopia of an average degree), at the open and closed eyes such feeling, that before eyes the heap of subjects and events in very fast rate "run", unpleasant sensations in heart, a photophobia, a boring from hum. Pressure thus can be - 1., 2. With rising diastolic and normal systolic, 3. With rising and systolic and diastolic pressure. A tachycardia up to 95-140 ud. In a minute. Pereodicheskoe feeling of internal pressure upon eyes. Pereodicheskoe a numbness of the face, arms or hand, backs, a stomach or belly and legs or foots (more often one face).
All this has appeared during pregnancy (since every day there were vegetative crisises on hypertonic type) and after a narcosis spent in April 2003 g by all this has amplified. After a narcosis me could not wake longly and I had a status which proceeds and on segodneshny day - as though all as in a dream, at opened or open eyes to me kazhetsja as though I sleep and on the contrary, in the evening when it is necessary to sleep at closing eyes I feel as though I sleep with the open eyes. This complaint has appeared outside of pregnancy, but only after a narcosis.
Treatment even slightly has not improved a status. The spent treatment - (TSipromil, Klonozepam, Fljuanksol - 6 months), Mildronat, Aktovegin, Veroshpiron.
Inspection.
1.
Echo of KG of a head
KK-147,4 mm
=MS=TH=79,0 Mm
V 3=2,0 mm
=10,8 %
The basic signal of M-echo on a median line, 3 ventricle of =2,0 mm
2.
REG heads
The left hemisphere - angiospastic type of disturbance of a cerebral hemodynamic, normal krovenapolnenie arterial vessels of a brain.
The right hemisphere - angiospastic type of disturbance of a cerebral hemodynamic, normal krovenapolnenie arterial vessels of a brain.
Pool left pozvonochnoj arteries - the mixed type of disturbance of a cerebral hemodynamic with prevalence of the vasomotor spasm, lowered krovenapolnenie arterial vessels of a brain.
Pool right pozvonochnoj arteries - the mixed type of disturbance of a cerebral hemodynamic with prevalence of the vasomotor spasm, lowered krovenapolnenie arterial vessels of a brain.
The conclusion - Volumetric pulsovoe krovenapolnenie within the limits of norm or rate in pool karotid, is moderate snizhenno in vertebrobazilljarnom pool. The tonus of arteries of a brain is raised or increased. Venous outflow is complicated.
3. UZDG
The spectrum of a blood flow is not changed. LSK on didymous arteries. MAT without significant assimetrii. A blood flow on NBA physiologic. The venous component on orbits is moderately expressed.
The conclusion - is not present hemodynamically significant stenoses.
4. EEG
Background rhythms a .-rhythm frequency 10,5-11..., amplitude up to 40 mkv, regestriruetsja in central-parietooccipital departments (it is a little bit displaced to front). In-rhythm frequency 21..., low amplitude, it is moderately expressed in frontally--temporal departments. In forward departments regestrirujusja diffusive or diffuse individual and group (? It is not legible) waves not exceeding amplitude 35-40 mkv., inclined to bilateral synchronization. On this background regestrirujutsja moderated or moderate bileteralno synchronous flashes of waves and, (?) ranges amplitude 70-100 mkv and 50 mkv accordingly, pereodicheski with peak accent or stress that srpava at the left, a little bit amplifying at functional assays (the photostimulation and a hyperventilation) .reaktsija is expressed to activation. Reaction usvo... (?) Rhythms it is smoothed or maleficiated. MPA it is not expressed.
The conclusion - moderately expressed changes EEG reguljatornogo character with dysfunction of -diencephalic departments of a brain.
NUCLEAR MAGNETIC RESONANCE
Are received 1 and 2 the weighed images sub and supratentoralnyh structures or frames and axial, saggitalnoj and face-to-face projections.
Median structures or frames are not displaced. Ventricles are not expanded, lateralnye - symmetric. subarohnoidalnye likvornye spaces are not expanded. Konveksitalnye sulcuses differentsirovanny. Stvolovye structures or frames without features. Focal changes in substance of a brain it is not revealed.
The pituitary body in sizes is not increased, its or his leg or pinch in median position.
In right gajmorovoj to a sinus (polyp) in the sizes up to 1012 mm, with sites krovoizlejanija is defined or determined pristenochnoe a thickening of a mucosa.
Mostomozzhechkovye angles without features. Tonsils of a cerebellum are located above line CHemberlena.
ELECTROCARDIOGRAM
Relative sinusovaja a tachycardia, the CARDIAC CONTRACTIONS RATE 90 minutes the Deviation or Rejection of an electric axis of heart to the left. polugorizontalnaja a position.
Rotation of heart along a longitudinal axis clockwise. Change of an atrial component as P-pulmonale. Attributes of change of a myocardium. Depression of amplitude QRS in thoracal abductions.
EhoKG
The aorta is not condensed, not expanded, joint-stock company = 3,2 sm (norm or rate 2,0-3,7) .levoe the auricle is not increased, LP 3,7 sm (the norm or rate 2,0-4,0) .polost a left ventricle is not expanded, KDR 4,9 sm (norm or rate 4,0-5,5), KSR 3,1 sm (norm or rate 2,5 - 3,8) .sokratimost a myocardium of a left ventricle satisfactory 0 (the norm or rate is less 28) .fv LZH 67 (norm or rate more than 59).
Zones gipo and akinezii - are not present. An interventricular septum not utolshchena, TMZHP 0,9 sm (norm or rate 0,7-1,1) .zadnjaja a wall of a left ventricle not utolshchena, TZSLZH 0,8 SM (norm or rate 0,7-1,1). A free wall of a right ventricle not utolshchena, TSPZH 0 (norm or rate up to 0,5). The aortal valve - cusps are not changed. The amplitude of disclosing is not reduced, AK 2,1 sm (the norm or rate is more 1,5) .mitralnyj the valve - cusps are not changed, the antiphase is. The right ventricle is not expanded, PZR 2,4 sm (norm or rate up to 2,9) .priznakov the pulmonary hypertensia is not present, SDLA 0 (norm or rate 25).
Dopplerografija-
Attributes of a failure mitral (1 degree) and trikuspidalnogo (1 degree) valves. Transmitralnyj a stream normal.
The CONCLUSION - cavities of heart are not expanded. Hemodynamically insignificant mitral and trikuspidalnaja a regurgitation.
Survey of the oculist - (fresh data).
OU - a cornea transparent. ../to average depth, an iris structural. Optical mediums - a destruction of a vitreous of both eyes. An eyeground - DZN light pink, the reduced sizes, border precise, arteries narrow, places thready, veins of normal calibre, a retina pink, without the centers.
The conclusion. A myopia of a weak degree. A radial keratotomy (1990)
OD=0,6--1,25d-1,0
OS = 0,5-1,5D-1,0
Vasomotor spasm of a retina.
After a while will be given holterovskogo monitorings +.
What presumably the diagnosis and tactics.
Thanks.
Complaints-
Constant headaches (all head, especially a nape, a forehead, orbits), little bit decreasing by the evening (when darkens in the street), a giddiness (is more correct - feeling as though you will lose consciousness), at height of intensifying of a pain pereodicheski a nausea (the vomiting was 1 time during acupuncture in occasion of head + fields of vision), intensifying be ill or sick at job with a computer, viewing of the TV, a phone conversation, job with the bent head, a sharpness of vision (though there is a myopia of an average degree), at the open and closed eyes such feeling, that before eyes the heap of subjects and events in very fast rate "run", unpleasant sensations in heart, a photophobia, a boring from hum. Pressure thus can be - 1., 2. With rising diastolic and normal systolic, 3. With rising and systolic and diastolic pressure. A tachycardia up to 95-140 ud. In a minute. Pereodicheskoe feeling of internal pressure upon eyes. Pereodicheskoe a numbness of the face, arms or hand, backs, a stomach or belly and legs or foots (more often one face).
All this has appeared during pregnancy (since every day there were vegetative crisises on hypertonic type) and after a narcosis spent in April 2003 g by all this has amplified. After a narcosis me could not wake longly and I had a status which proceeds and on segodneshny day - as though all as in a dream, at opened or open eyes to me kazhetsja as though I sleep and on the contrary, in the evening when it is necessary to sleep at closing eyes I feel as though I sleep with the open eyes. This complaint has appeared outside of pregnancy, but only after a narcosis.
Treatment even slightly has not improved a status. The spent treatment - (TSipromil, Klonozepam, Fljuanksol - 6 months), Mildronat, Aktovegin, Veroshpiron.
Inspection.
1.
Echo of KG of a head
KK-147,4 mm
=MS=TH=79,0 Mm
V 3=2,0 mm
=10,8 %
The basic signal of M-echo on a median line, 3 ventricle of =2,0 mm
2.
REG heads
The left hemisphere - angiospastic type of disturbance of a cerebral hemodynamic, normal krovenapolnenie arterial vessels of a brain.
The right hemisphere - angiospastic type of disturbance of a cerebral hemodynamic, normal krovenapolnenie arterial vessels of a brain.
Pool left pozvonochnoj arteries - the mixed type of disturbance of a cerebral hemodynamic with prevalence of the vasomotor spasm, lowered krovenapolnenie arterial vessels of a brain.
Pool right pozvonochnoj arteries - the mixed type of disturbance of a cerebral hemodynamic with prevalence of the vasomotor spasm, lowered krovenapolnenie arterial vessels of a brain.
The conclusion - Volumetric pulsovoe krovenapolnenie within the limits of norm or rate in pool karotid, is moderate snizhenno in vertebrobazilljarnom pool. The tonus of arteries of a brain is raised or increased. Venous outflow is complicated.
3. UZDG
The spectrum of a blood flow is not changed. LSK on didymous arteries. MAT without significant assimetrii. A blood flow on NBA physiologic. The venous component on orbits is moderately expressed.
The conclusion - is not present hemodynamically significant stenoses.
4. EEG
Background rhythms a .-rhythm frequency 10,5-11..., amplitude up to 40 mkv, regestriruetsja in central-parietooccipital departments (it is a little bit displaced to front). In-rhythm frequency 21..., low amplitude, it is moderately expressed in frontally--temporal departments. In forward departments regestrirujusja diffusive or diffuse individual and group (? It is not legible) waves not exceeding amplitude 35-40 mkv., inclined to bilateral synchronization. On this background regestrirujutsja moderated or moderate bileteralno synchronous flashes of waves and, (?) ranges amplitude 70-100 mkv and 50 mkv accordingly, pereodicheski with peak accent or stress that srpava at the left, a little bit amplifying at functional assays (the photostimulation and a hyperventilation) .reaktsija is expressed to activation. Reaction usvo... (?) Rhythms it is smoothed or maleficiated. MPA it is not expressed.
The conclusion - moderately expressed changes EEG reguljatornogo character with dysfunction of -diencephalic departments of a brain.
NUCLEAR MAGNETIC RESONANCE
Are received 1 and 2 the weighed images sub and supratentoralnyh structures or frames and axial, saggitalnoj and face-to-face projections.
Median structures or frames are not displaced. Ventricles are not expanded, lateralnye - symmetric. subarohnoidalnye likvornye spaces are not expanded. Konveksitalnye sulcuses differentsirovanny. Stvolovye structures or frames without features. Focal changes in substance of a brain it is not revealed.
The pituitary body in sizes is not increased, its or his leg or pinch in median position.
In right gajmorovoj to a sinus (polyp) in the sizes up to 1012 mm, with sites krovoizlejanija is defined or determined pristenochnoe a thickening of a mucosa.
Mostomozzhechkovye angles without features. Tonsils of a cerebellum are located above line CHemberlena.
ELECTROCARDIOGRAM
Relative sinusovaja a tachycardia, the CARDIAC CONTRACTIONS RATE 90 minutes the Deviation or Rejection of an electric axis of heart to the left. polugorizontalnaja a position.
Rotation of heart along a longitudinal axis clockwise. Change of an atrial component as P-pulmonale. Attributes of change of a myocardium. Depression of amplitude QRS in thoracal abductions.
EhoKG
The aorta is not condensed, not expanded, joint-stock company = 3,2 sm (norm or rate 2,0-3,7) .levoe the auricle is not increased, LP 3,7 sm (the norm or rate 2,0-4,0) .polost a left ventricle is not expanded, KDR 4,9 sm (norm or rate 4,0-5,5), KSR 3,1 sm (norm or rate 2,5 - 3,8) .sokratimost a myocardium of a left ventricle satisfactory 0 (the norm or rate is less 28) .fv LZH 67 (norm or rate more than 59).
Zones gipo and akinezii - are not present. An interventricular septum not utolshchena, TMZHP 0,9 sm (norm or rate 0,7-1,1) .zadnjaja a wall of a left ventricle not utolshchena, TZSLZH 0,8 SM (norm or rate 0,7-1,1). A free wall of a right ventricle not utolshchena, TSPZH 0 (norm or rate up to 0,5). The aortal valve - cusps are not changed. The amplitude of disclosing is not reduced, AK 2,1 sm (the norm or rate is more 1,5) .mitralnyj the valve - cusps are not changed, the antiphase is. The right ventricle is not expanded, PZR 2,4 sm (norm or rate up to 2,9) .priznakov the pulmonary hypertensia is not present, SDLA 0 (norm or rate 25).
Dopplerografija-
Attributes of a failure mitral (1 degree) and trikuspidalnogo (1 degree) valves. Transmitralnyj a stream normal.
The CONCLUSION - cavities of heart are not expanded. Hemodynamically insignificant mitral and trikuspidalnaja a regurgitation.
Survey of the oculist - (fresh data).
OU - a cornea transparent. ../to average depth, an iris structural. Optical mediums - a destruction of a vitreous of both eyes. An eyeground - DZN light pink, the reduced sizes, border precise, arteries narrow, places thready, veins of normal calibre, a retina pink, without the centers.
The conclusion. A myopia of a weak degree. A radial keratotomy (1990)
OD=0,6--1,25d-1,0
OS = 0,5-1,5D-1,0
Vasomotor spasm of a retina.
After a while will be given holterovskogo monitorings +.
What presumably the diagnosis and tactics.
Thanks.