Cervical vertigo in the elderly
Introduction
Introduction to cervical vertigo in the elderly Cervical vertigo is a series of clinical signs and symptoms such as vertigo, nausea and vomiting caused by vertebral artery stimulation or compression, resulting in insufficient blood supply to the vertebral-basal artery. It is a vertebral artery type cervical spondylosis, which is a common disease in the elderly. one. Vertebral artery: the first branch of the subclavian artery, which goes upward along the inner edge of the anterior scalene muscle and enters the transverse protrusion of the sixth cervical vertebra, but also sees the transverse process from the 5th, 4th, 3rd or 7th cervical vertebrae. Hole piercing. Into the cranial, Da Yan medullary sulcus plane, the left and right vertebral arteries merge into the basilar artery. The vertebral artery rises vertically in the transverse abduction hole, and runs out from the transverse process of the transverse process, and then bends upward, and vertically ascends to the transverse perforation of the atlas. It passes through the transverse hole of the atlas and bypasses the atlas. The lateral block (superior at the atlas) to the vertebral artery sulcus on the lateral side of the posterior arch of the atlas, turning to the front, entering the spinal canal along the vertebral artery groove at the outer edge of the posterior membrane of the atlas (or through the membrane), through the meninges After the ascending, from the large hole in the pillow into the cranial cavity, the occipital vertebral artery surrounds the superior articular process of the atlas, which is located on the lateral, posterior and medial sides of the articular process, with a large degree of tortuosity. When the relationship between the vertebrae changes, such as excessive head tilt or rotation, the vertebral artery can be affected, narrowed or blocked, leading to brain stem ischemia, and the vertebral-basal artery branch supplies the occipital lobe of the cerebral hemisphere. Part of the leaf, most of the posterior thalamus, a small part of the lower part of the thalamus, the brainstem, cerebellum and upper part of the spinal cord. basic knowledge The proportion of the disease: the incidence rate of the elderly over 60 years old is about 0.04%-0.1% Susceptible people: the elderly Mode of infection: non-infectious Complications: fracture
Cause
The cause of cervical vertigo in the elderly
(1) Causes of the disease
Causes of vertebral-basal artery insufficiency in the elderly: The elderly have the following physiological and pathological features.
1 bone hyperplasia, bone spurs can stimulate or compress the vertebral artery, resulting in reduced blood flow.
2 vascular lesions, atherosclerosis is more common in the elderly, prone to vertebral artery insufficiency.
3 cervical disc degeneration, narrow intervertebral space, cervical vertebrae relatively shortened, vertebral artery relatively long, folding or distortion, affecting vertebral artery blood circulation.
4 cervical vertebrae dislocation, cervical disc degeneration, narrow intervertebral space, joint capsule and intervertebral ligament relaxation, cervical instability, under the action of external forces, easy to cause cervical dislocation, stimulate the sympathetic plexus around the vertebral artery, or directly compress the vertebra Arteries, stenosis or stenosis of the vertebral artery, blood flow is reduced.
(two) pathogenesis
The cervical vertebra is located between the weight of the thoracic vertebrae that lacks activity and the head. The mobility is large, and it is prone to accumulative strain, which makes the stability of the cervical vertebrae worse. Unexpected operation or whiplash injury that usually does not care, such as sitting When the car is suddenly braking, the inertia is forward, and suddenly stops. The head moves forward first, then suddenly leans back, which can cause a single (multiple) longitudinal displacement along the frontal axis, the sagittal axis or the longitudinal axis, if the cervical intervertebral disc It has been degenerated, the intervertebral space is narrowed, the joint capsule and intervertebral ligament are loose, and the cervical vertebra is unstable. Under the action of external force, it is easier to shift the single (multiple) cervical vertebrae. Because of cervical dislocation, the intervertebral joint is staggered, and the vertebrae The soft tissue is stretched, the spinal canal or intervertebral space is also narrow, the cervical intervertebral disc is protruding, etc. The cervical vertebrae can be straightened on the X-ray film, and the cervical curvature can be straightened, reversed, angled, interrupted, etc. If the damage is light, the human body adapts. The function of compensation can not produce clinical symptoms, that is, establish compensatory intervertebral internal and external balance, for the compensation period, such as compensatory spinal lateral changes. If the patient receives timely treatment, correct the displaced cervical vertebrae and restore the normal vertebrae. body In order to maintain the balance of force between the vertebral bodies, the cervical vertebrae produce bone hyperplasia to increase the area of force and reduce the local pressure. The hyperplasia of the bone of the hook joint can stimulate the sympathetic plexus around the vertebral artery. Caused by the clinical symptoms of vertebrobasilar insufficiency, vertebral body hyperosteogeny or ligamentum flavum hypertrophy caused by spinal stenosis, compression of the spinal cord, cervical spondylotic myelopathy, posterior joint hyperosteogeny, extending into the intervertebral foramen, Stimulation, oppression of the cervical spinal nerve roots, neck, shoulder, arm pain, numbness of the nerve root symptoms, such as heavier trauma, cervical vertebrae displacement, posterior joint disorder, can directly stimulate, oppress the nerve root, sympathetic nerve, or make the vertebra The arteries are distorted, and a series of clinical symptoms of cervical spondylosis appear. When the vertebral body is displaced, it will inevitably lead to hemiplegia. Hemiplegia can be touched on the surface of the body. The doctor uses the cervical spine to reduce the spine. The displaced vertebral body is restored to the original anatomical position, and the stimulation or compression of the nerve, blood vessel and spinal cord is relieved, and the clinical symptoms are alleviated or disappeared.
Pathology: The main cause of cervical spondylosis is injury and/or regression. Whether it is caused by direct or indirect external force, acute or chronic neck injury can cause slight changes in the anatomical position of the cervical vertebrae, causing nerves and blood vessels. Symptoms of compression such as the spinal cord.
1. Single (multiple) cervical spine shift
Degeneration of the cervical vertebrae or intervertebral disc narrows the intervertebral space, the joint capsule and intervertebral ligament are loose, and due to the large range of neck movement and gravity, it causes cumulative damage, which aggravates cervical degeneration and instability, and unexpected damage. Or whiplash injury that is usually not noticed, can cause slight displacement of single or multiple cervical vertebrae along the frontal axis and sagittal axis, and the cervical spine is staggered or subluxated, causing a series of clinical symptoms and signs.
2. Degenerative changes of the cervical disc
The cervical intervertebral disc is composed of a nucleus pulposus, a fibrous annulus and a cartilage plate.
(1) Nucleus pulposus: water is reduced, and the fibrous network and mucoid matrix are gradually replaced by fibrous tissue and chondrocytes. Finally, a fibrocartilage entity causes the intervertebral disc to narrow, so that the pathological changes are unbalanced in each intervertebral disc, and the weight changes. Early and fast, the human body begins to degenerate from the age of 30. When it is over 50 years old, the change is already obvious.
(2) Fibrous ring: After 20 years old, the fiber ring stops developing and begins to denature. It shows that the fiber becomes thicker, the transparency changes, the elasticity decreases, and it is easy to be broken. The elasticity is reduced after the fiber ring is denatured, and the muscle is pulled up and down. Gravity and labor, trauma and other factors affect the surrounding bulging to narrow the gap.
(3) Cartilage plate: cartilage plate degeneration, gradually thinning, easy to be damaged by the nucleus pulposus, causing the cartilage plate to lose the semi-permeable membrane effect, promote the degeneration of the annulus fibrosus and nucleus pulposus, small vessels can be cancellous bone The nucleus pulposus grows, forms granulation, and absorbs the characteristics of the nucleus pulposus to become fibrous tissue. As the age increases, the degeneration increases, and the intervertebral disc becomes fibrotic. Therefore, the elderly have few symptoms of acute disc herniation.
3. Vertebral bone hyperplasia
With the increase of age, the water content of the nucleus pulposus decreases, and it gradually dehydrates. Its elasticity and tension decrease, it is easy to be compressed, and the fiber ring bulges outward, stimulating the vertebral body to form bone hyperplasia, such as fissures in the fiber ring. , causing the nucleus pulposus to escape.
Prevention
Cervical vertigo prevention in the elderly
According to Liu Jinsheng's neck exercise method to prevent the occurrence of cervical spondylosis.
Neck operation
(1) Neck competition: standing, two feet open and shoulder width, hands akimbo, look up at the sky, restore, then open the shoulders and shoulder width, hands akimbo, look down at the ground, restore, ask to breathe naturally, waist Do not participate in the event.
(2) Looking backwards: the posture is the same as before, the right arm turns to the right with the head and neck, and the right hand is visually restored. Then the left arm turns to the left with the head and neck, and the left hand is visually restored.
(3) Stretching the sea before: the posture is the same as before, the head and neck are stretched forward and turned to the right front, and the double is currently under the view and restored; then, the head and neck are stretched forward and turned to the left front, and the double is currently under the view and restored.
(4) Looking back at the moon: the head and neck turn to the right and the upper right as far as possible, and the eyes turn to the right and the upper part to restore; the head and neck turn to the left and the upper side, and the eyes are left and the upper side and restored.
(5) Golden Lion shakes his head: the head and neck are circled around the left and right.
2. Cervical manipulation
(1) Punch movement: Freehand or hand-held dumbbells with a weight of 1~2kg are inclined forward, sideways, and above, and can be made 4 to 8 times in all directions.
(2) posterior extension of the chest to expand the chest: two elbow flexion, force the posterior rotation and expand, then expand, repeat 8 to 12 times.
(3) There is resistance movement: the two hands cross over the head, and the two cross hands give a certain resistance when the head is raised, for 6-8 times.
(4) Body lateral flexion movement: When the head and neck are straight and the body is flexed sideways, the head and neck are flexed sideways, alternating left and right, 4 to 8 times each.
(5) Shrug movement: stand upright, both shoulders force up at the same time, relax and fall, then shrug your shoulders and then force them forward or backward alternately around the ring, repeat 4 to 8 times.
(6) Swinging shoulder movement: Both hands are supported by the side shoulders, and the two elbows are respectively arced for rotary motion, alternating between front and back, each 6 to 8 times.
(7) Head tilting movement: the head flexes to the bottom and closes the chest for a while, then leans back to the maximum angle and stops for a while, repeating 6 to 8 times.
(8) head lateral flexion movement: head side flexion (head close to the same side shoulder), restoring for a while and then flexing to the other side, repeating 6-8 times.
(9) Turning the head to the left and right: The head rotates to one side, and after stopping, it stops for a while and then repeats to the other side for 6-8 times.
(10) Head-surrounding movement: the head is in front of the front, left, back, and right around the movement. After stopping for a while, then moving forward, right, back, and left, and moving around, trying to move the range is large, slow, repeat 6 to 8 times.
Complication
Cervical vertigo complications in the elderly Complications
Can be complicated by cerebrovascular accidents, fractures, etc.
Symptom
Cervical vertigo symptoms in the elderly Common symptoms Trips, vertigo, swallowing difficulties, nystagmus, cervical vertigo, tinnitus, nausea, hoarseness, paralysis, deafness
Cervical vertigo
For paroxysmal vertigo, sometimes accompanied by nausea, vomiting, tinnitus, deafness, nystagmus, when the head is over-reverse or turning a certain position, when the back is tilted or twisted, the symptoms disappear or are obviously relieved, also known as positionality. Dizziness, cervical vertigo mostly occurred in the 40-year-old or older, there is no significant difference between men and women, blood pressure is basically normal, sudden onset, often due to morning or lunch break or wake up suddenly vertigo.
2. headache
Most of them are post-occipital pain or migraine, which can be painful, jumping or spreading pain. Some people take painkillers all the year round or suspect that there are space-occupying lesions in the brain.
3. Stumble.
4. Brain stem symptoms
Limb numbness, abnormal feeling, severe cases may occur in the contralateral limbs and contralateral cranial nerve symptoms, but also dysphagia, ruminant, pharyngeal reflex disappeared, hoarseness, eye muscle paralysis, diplopia, unclear , Horner et al.
Examine
Examination of cervical vertigo in the elderly
Hemoglobin, blood sugar, blood lipids, urea nitrogen, etc. should be checked.
1. X-ray cervical vertebra can be seen in cervical vertebrae, disc, uncinate joint degeneration and ligament calcification, cervical curvature changes straightening and other changes.
2. Brain ultrasound can reduce the blood flow of the vertebral basilar artery.
Diagnosis
Diagnosis and diagnosis of cervical vertigo in the elderly
Diagnostic criteria
Age
More than 40 years old.
2. The onset of vertigo is often associated with changes in neck position.
3. The neck is tilted backwards, and when it is rotated, it can induce dizziness or nausea.
4. May be associated with radiculopathy.
5. Sudden onset, often due to sudden vertigo from getting up or turning, often accompanied by horizontal tremors of the eyeball.
6. Cervical examination
The neck activity is limited, the diseased vertebral body spine is hemiplegia, the paravertebral spine is tender, and the neck 2 spinous process is more common. Because the vertebral artery enters the transverse process, it rises vertically, from the 2nd cervical vertebrae to the occipital foramen. Before the vertebral artery has multiple curvatures in this segment, the vertebral artery blood flow is also hindered.
7. Cerebral blood flow diagram
The occipital milk leads, the vertebral-basal artery is insufficiently supplied, and the torsion neck test is positive.
8. Cervical X-ray film
The positive side piece, the left and right oblique position and the open mouth piece show that the physiological curve of the cervical vertebra becomes straight, reversed, angled or interrupted, bone hyperplasia, posterior annulus of the posterior vertebrae, and the distance between the blocks on both sides of the toothed spur is not equal. .
Differential diagnosis
Clinical should be differentiated from peripheral vertigo, central vertigo and so on.
