Difficulty with eyes closed
Introduction
Introduction It is difficult to set up a closed eye, also known as the "Romberg sign": the patient's feet stand close together, his hands stretched forward, then close his eyes and observe his posture, which is one of the manifestations of ataxia. The sensory ataxia is characterized by unstable standing after closing the eyes, and a stable standing posture when blinking, which is called Romberg sign positive. Cerebellar ataxia and closed eyes are unstable, but more obvious when the eyes are closed. Specifically, one side of the cerebellar lesion or one side of the vestibular lesion is dumped to the disease side, and the cerebellar verrucous lesion is tilted backward.
Cause
Cause
Ataxia is (ataxia) refers to the coordination disorder of exercise in the case of normal muscle strength. The amplitude and coordination of the voluntary movement of the limbs are disordered, and the posture and balance of the body cannot be maintained. However, it does not include coordination disorders when the limbs are mildly paralyzed, voluntary movement deviation caused by ophthalmoplegia, voluntary exercise difficulties caused by visual impairment, and apraxia caused by brain lesions. According to different lesions, ataxia can be divided into four types: 1 deep sensory ataxia; 2 cerebellar ataxia; 3 vestibular labyrinth ataxia; 4 brain-type ataxia. The general term "aphrodisiac" refers to cerebellar ataxia.
1. Sensory: Deep sense reflects the position and direction of movement of various parts of the body to the central nervous system. The causes are: 1 peripheral nerve or radiculopathy; 2 subacute combined degeneration of the spinal cord, skull base deformity, myelopathy, tumor; 3 brain stem vascular diseases such as infarction, hemorrhage, multiple sclerosis, tumor; 4 thalamic parietal pathway or Parietal vascular disease, tumor.
2, cerebellum: the cerebellum is the regulation center of exercise. The function of these structures is all done under the unified control of the cerebral cortex. The causes are: 1 hereditary; 2 primary or metastatic tumor; 3 vascular such as infarction, hemorrhage; 4 inflammatory such as acute cerebellum, abscess; 5 poisoning such as alcohol, food, drugs, harmful gases, etc.; Myelin sheath; 7 hypoplasia or malnutrition; 8 hereditary; 9 trauma; 10 calcification; (11) malformation.
Examine
an examination
Related inspection
Brain CT examination of nervous system examination
Patients with clinically closed eyes are difficult to check for:
First, physical examination
Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.
Second, laboratory inspection
Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Such as: nervous system examination, brain CT examination.
Diagnosis
Differential diagnosis
Differential diagnosis of closed eyes
1. Balanced Mutual Aid Movement: The Torso-Community Movement. Mainly observe the patient's standing posture and gait. Pay attention to whether the patient can maintain the upright posture when standing on both sides of the heel and toe, and whether it is shaking, slightly moving, or even dumping. Check when blinking first and then closing eyes. If it is dumped, pay attention to the direction and speed of the dump. When standing in the blink of an eye, you can maintain an upright position. If you close your eyes, you may have a swaying or even a dumping. Patients with milder conditions can use the push-pull test: push from the right shoulder to the left side, then push to the other side, or use both hands to support the pelvis, first push from one side to the other, then push to the other side To see if you can continue to stand upright. It is also possible for the patient to stand in front of the two feet in a straight line, or stand on one foot and left alone, and then observe whether it can stand still. Checking the gait can cause the patient to walk or step around the line, paying attention to the size of the step, the movement of the two feet and the direction of the body.
Secondly, observe whether the patient can sit or stabilize when sitting. Severe torso of the torso can not be stabilized, and there may be rhythmic tremors in the front, back or left and right sides of the body or head, several times per second.
2, non-balanced mutual aid movement: mainly the limbs mutual aid movement. First, observe whether the daily activities of the patient's dressing, buttoning, eating, and taking things are properly coordinated. Simple cerebellar atrophy can be caused by many causes. Although there are many causes, its CT and MRI manifestations have their common characteristics. They can be atrophied in a certain part, but their CT diagnosis should include two or more signs:
1 cerebellar sulcus enlarges, more than 1mm;
2 The cerebellar cerebral cistern is enlarged, more than 1.5mm (the distance between the upper edge of the cerebellum and the edge of the rock bone should be measured);
3 The fourth ventricle is enlarged by more than 4 mm;
4 The cerebellum is enlarged on the pool. The simple expansion of the fourth ventricle and the appearance of a large occipital pool do not indicate the presence of cerebellar atrophy. Pay attention to whether the patient can maintain the upright posture when standing on both sides of the heel and toe, and whether it is shaking, slightly moving, or even dumping. Check when blinking first and then closing eyes. If it is dumped, pay attention to the direction and speed of the dump. When standing in the blink of an eye, you can maintain an upright position. If you close your eyes, you may have a swaying or even a dumping.
