The guy was physically healthy, but his head let him down

A guy who played sports and had a fairly healthy appearance suddenly began to suffer from dizziness. The symptom of some disease manifested itself for many years, constantly growing. Then the guy got scared and went to the doctor.

Before going to the doctor, the guy received, as xrust thought, the last signal from the body. As he reversed out of the garage, he habitually placed his right hand on the passenger seat and turned his head to the right, craning his neck. And then it began — my stomach shrank, my ears began to buzz, my vision began to disappear, and my head began to spin. The situation was saved by the immediate return of the head to its normal position.

At the doctor, the guy could not remember when this happened for the first time. Perhaps two or three years ago. It was strange at first, but when it didn't happen again, he forgot about it. Then, a few months later, he drove out of the garage again, and bam! — everything happened again.

The surgeon listened to his description; he had never heard of such symptoms before. He ordered an MRI of the cervical spine, which showed that the man had a degenerative disease. The surgeon said that surgical fusion of the affected intervertebral discs would probably relieve the neck pain, but did not find it would help with the dizziness attacks. The man agreed to the operation.

At a re-examination a few months later, the patient reported that the neck pain had gone away, but the strange rotation of the world remained. The surgeon was at a loss.

Now it was the turn of the neurologist, whom the surgeon advised to contact. After examination, the neurologist suggested that the man had a blockage in the artery that supplies blood from the heart up the spine to the cerebellum. The cerebellum is the part of the brain that coordinates body and eye movements, as well as balance, he explained to the patient.

The neurologist referred the patient for a CT angiogram, which showed that the vertebral artery on the right side had narrowed and then completely disappeared as it ran through the neck to the brain. This was probably due to atherosclerosis, although he may have been this way from birth. However, the patient's left artery was normal, which raised the question of the reasons for the periodic disruption of blood supply. Richard referred the patient for an examination of the inner ear, where much of our sense of body position and balance originates. Nothing was revealed. Ultrasound of the carotid arteries was also inconclusive. Both the patient and the doctor were upset.

The neurologist referred the guy to a doctor who specialized in dizziness. After listening to the patient's story, he asked a question that no one had asked him before: could he demonstrate the movement that caused the symptoms? The patient extended his right arm as if placing it on the passenger seat, and then turned his head as far as possible over his right shoulder. Nothing happened.

The physician explained to the patient and his wife that the system that controls balance includes the cerebellum, inner ear, and eyes. He will need to test each of these systems to determine the problem. To record eye movements, the patient will need to wear glasses with an infrared camera. He was strapped into a chair in a darkened room and glasses were placed on his head. He then followed the instructions and began to move his head from side to side and up and down. The chair rotated. But the negativity did not appear.

Then the doctor asked him to repeat the head turn that caused the dizziness. The patient extended his arm and stretched his neck as far to the right as possible, lowering his chin slightly to simulate movement in a car. Suddenly his stomach tightened and he felt a buzzing sensation, and he quickly straightened his head. In the goggle camera footage, Kheradmand saw the man's eyes flicker downward a couple of times. This is exactly what he was looking for. Loss of blood supply to the cerebellum causes the gaze to shift toward the floor, a symptom called downward nystagmus.

To determine the location of the blockage, another angiogram will be required, with a contrast agent injected into the bloodstream. Two previous tests were inconclusive. They try again, and this time the doctor wanted the patient to wear glasses. This way, they will be able to prove that the cause of his symptoms was the position of his head, as well as the disruption of blood supply to the cerebellum, as indicated by his downward nystagmus.

A couple of weeks later the man underwent examination. He was injected with a contrast agent and his arteries lit up on the screen. Having received instructions, he assumed a position: his arm was extended, his head was turned and tilted down. Nothing. He tried again and again. They were ready to give up when he made his last attempt. And then it happened. His stomach tightened; he instantly felt dizzy. At that moment, the doctor saw his eyes slide down. The angiogram showed that in this position, blood did not enter the cerebellum through the left vertebral artery.

The neurosurgeon assigned to this case had not encountered such cases; this is a rare occurrence because it requires one artery to be blocked and the other to be obstructed by some anatomical abnormality. But, he said, it was important to prevent the man from having a stroke.

The patient was operated on. His wife sat and then paced around the waiting room for four hours. Finally, the surgeon appeared. Surgeons were able to pinpoint the location of the blockage in the blood vessel, but were unable to remove the blocking structure, he said. Instead, they had to fusion the upper part of the cervical spine to prevent the patient from being able to assume the painful position. According to the surgeon, the symptoms should not recur.

The operation was done a year and a half ago, and, of course, the man has not had an attack since then. He notices limited neck mobility, but he managed to cope with it.

Xrust The guy was physically healthy, but his head let him down