Vertigo
Introduction
Introduction to vertigo Dizziness is a dynamic or positional illusion caused by the body's obstacle to spatial localization. It involves multiple disciplines. Most people experience this disease throughout their lives. According to statistics, vertigo accounts for 5% of medical outpatients and 15% of otolaryngology clinics. Dizziness can be divided into true vertigo and pseudo vertigo. True vertigo is caused by diseases of the eye, the body or the vestibular system, and has obvious foreign objects or a sense of rotation. False vertigo is caused by systemic diseases, such as cardiovascular disease, cerebrovascular disease, anemia, uremia, drug poisoning, endocrine diseases and neurosis. There are almost dizziness symptoms, and patients feel "floating." Swing", there is no clear sense of rotation. basic knowledge The proportion of illness: 10% Susceptible people: no special people Mode of infection: non-infectious Complications: ataxia, fracture, coronary insufficiency
Cause
Cause of vertigo
Causes of dizziness:
First, false vertigo
Common in cardiovascular disease, fever, anemia, toxic diseases, metabolic diseases, visual disorders, refractive errors, cervical spondylosis, menopausal syndrome and neurosis.
Second, true vertigo
(a) vestibular peripheral lesions
Otitis media, such as purulent labyrinth and toxic labyrinthitis, drug poisoning, such as streptomycin, neomycin, phenytoin and kanamycin poisoning. Lost trauma and surgical sequelae. Oral vertigo such as ear sclerosis and otolith. Meniere syndrome, etc.
(2) Central part
1, brain stem lesions: a, tumors such as cerebellar cerebral horn occlusion lesions, fourth ventricle tumors, brain stem tumors. b, vertebrobasilar system blood circulation disorders, such as cranial vertigo caused by insufficient blood supply to the basilar artery, cerebellar posterior arterial thrombosis, cervical spondylosis and other vertebral artery insufficiency. c, inflammation of the brain stem, multiple sclerosis, posterior fossa lesions, inflammation of the vestibular neurons. d, brain stem trauma and congenital malformations of the posterior cranial fossa.
2, cortical lesions: temporal lobe tumor or localized inflammation, cerebrovascular disease, epilepsy and vascular headache, inflammation, degenerative diseases, craniocerebral trauma, epilepsy and so on.
Prevention
Dizziness prevention
Because the symptoms of vertigo involve multiple disciplines and multiple diseases, it is difficult to prevent diseases. There are often no signs of dizziness, and some incentives are not yet clear, such as peripheral vertigo vestibular neuritis, 30% have a history of early cold, speculated that viral infection is the cause of the disease. However, most of the cold does not necessarily cause vestibular neuritis, so there is no good intervention in the early stage of the disease. Central vertigo should be examined early for MRI and DSA, which will help diagnose and treat related diseases.
Complication
Dizziness complications Complications, ataxia, coronary artery, insufficient blood supply
Dizziness can lead to multiple system complications, which are harmful to both psychology and physiology.
1, vestibular system function damage: vertigo patients will have rotation and vomiting during the attack period, and will also cause labyrinth, vestibular, cochlear organ damage, resulting in cochlear hair cell death and loss of vestibular function, which may cause tinnitus, deafness, ataxia and other hazards Sex.
2, neurological complications: middle-aged and elderly patients, multiple episodes can affect the cerebral vascular regulation function and brain microcirculation, increase the lack of blood supply to the brain, induce cerebral infarction embolism. If not treated in time, it is easy to cause "thinking decline, headache dementia, cerebral thrombosis, cerebral hemorrhage, hemiplegia, stroke hemiplegia, and even sudden death."
3, social barriers: affect communication, life circle shrink, mental stress and so on.
4, accidental injury: normal activities such as pit side, well edge, crossing the road, tourism mountaineering, etc. due to fear of sudden onset of vertigo, have become dangerous activities, which may lead to falls, fractures and other dangers.
Symptom
Symptoms of vertigo Common symptoms Dizziness and tinnitus
Clinical manifestations:
1, peripheral vertigo
The vertigo caused by the inner ear labyrinth or the vestibular part and the extracranial segment of the vestibular nerve (in the internal auditory canal) is peripheral vertigo, including acute labyrinthitis and Meniere's disease. Its characteristics are: 1 vertigo is severe rotation, short duration, head position or body position change can make vertigo increase significantly. 2 nystagmus: nystagmus and vertigo attacks exist simultaneously, mostly horizontal or horizontal plus rotatory nystagmus. Usually there is no vertical nystagmus, the amplitude can be changed, the nystagmus can be reduced or disappeared after hours or days, and the nystagmus is more obvious when gazing at the healthy side. Head-induced nystagmus is mostly fatigue, and temperature-induced nystagmus is more common in semicircular canal paralysis. 3 balance obstacles: mostly rotatory or up and down and left and right swinging movement sense, standing unstable, spontaneous dumping, static upright test multi-directional nystagmus slow phase dumping. 4 autonomic symptoms: such as nausea, vomiting, sweating and pale. 5 often accompanied by tinnitus, hearing impairment, and no brain damage.
2, central vertigo
It refers to vertigo caused by vestibular nucleus, brainstem, cerebellum and cerebral temporal lobe lesions. Features: 1 The degree of vertigo is relatively light, and the duration is long. It is rotatory or moving to one side. It can be relieved after closing the eyes, and has nothing to do with head or body position changes. 2 eye tremor is large, can be a single vertical nystagmus and / or horizontal, rotating type, can exist for a long time and the intensity does not change. The nystagmus direction is not consistent with the lesion side, and the dumping direction of the spontaneous dumping and the static upright test is inconsistent. 3 balance barrier: the performance of rotation or movement to one side, standing instability, most vertigo and balance disorders are inconsistent. 4 autonomic symptoms are not as obvious as the surrounding. 5 no semi-regulatory paralysis, hearing impairment and so on. 6 can be associated with brain damage, such as cranial nerve damage, extraocular muscle paralysis, facial paralysis, ball paralysis, limb paralysis, high intracranial pressure.
Common vertigo:
1, otolithic disease
Most common in the clinic, more visits to the Department of Otorhinolaryngology. The performance of vertigo is related to the head position. The onset is sudden and begins to be persistent vertigo. After a few days, it is relieved and turned into paroxysmal vertigo. However, dizziness occurs when the head is in a certain position, which lasts for several tens of seconds, and vertigo can be reduced or disappeared when turning or reversing the head position. Significant nystagmus can be seen, and the duration of vertigo varies greatly. Most of the stuns are relieved or disappeared within a few hours or days after the onset.
2, Meniere's disease
The clinical manifestation is that the vertigo is intermittent and recurrent, with several days, months, and years. It often happens suddenly. At the beginning, the vertigo reaches the most serious degree. The head activity and the blinking are intensified. It is often accompanied by dumping. It is in a state of panic due to severe sense of rotation and movement. It is accompanied by tinnitus, deafness, nausea, vomiting, and complexion. Pale, slow pulse, decreased blood pressure and nystagmus. Each duration lasts from a few minutes to a few hours, and the individual is in a continuous state for several consecutive days. Tired and sleepy after each episode. Intermittent balance and hearing return to normal. After multiple episodes, vertigo is attenuated with the increase of deafness on the affected side, and vertigo disappears when it develops to complete deafness.
3, vertebral basilar artery VBA system ischemic lesions
There is nystagmus without other symptoms and signs of the nervous system. According to the clinical manifestations are divided into: 1 short-term ischemic episodes of seizures without timing, can be several times a day or a few days, usually a few minutes to half an hour to ease or disappear. The lighter ones are only dizzy and unstable, and the frequent episodes of severe cases progress to complete labyrinthine strokes. 2 After the onset of progressive stroke, dizziness, tinnitus, and deafness continued to progress, reaching a peak several days later. 3 hours after the onset of complete stroke, dizziness, instability, tinnitus, deafness peak, obvious nystagmus. Symptoms can be gradually reduced after a few weeks. Hearing disorder dizziness is often left.
There are other lesions that can cause dizziness, which are all areas of vertigo, such as: cerebellar hemorrhage, cervical lesions, intracranial tumors, craniocerebral trauma, drug or toxic poisoning, inflammatory demyelinating diseases.
Examine
Examination of vertigo
1, otolithic disease
Most common in the clinic, more visits to the Department of Otorhinolaryngology. The performance of vertigo is related to the head position. The onset is sudden and begins to be persistent vertigo. After a few days, it is relieved and turned into paroxysmal vertigo. However, dizziness occurs when the head is in a certain position, which lasts for several tens of seconds, and vertigo can be reduced or disappeared when turning or reversing the head position. Significant nystagmus can be seen, and the duration of vertigo varies greatly. Most of the stuns are relieved or disappeared within a few hours or days after the onset.
2, Meniere's disease
(1) Ear examination
External auditory canal examination, vestibular function examination, nystagmus electrogram, and hearing examination VEP/BAEP.
(2) Neurological examination
Examine the part related to the vestibular system, the star trail test, the partial test, the visual acuity and the fundus examination.
(3) Dizziness examination caused by other diseases in internal medicine
More comprehensive medical examinations should be done as much as possible, such as blood pressure and pulse testing.
(4) Image and electrophysiology related inspection
Head CT, CTA, brain MRI, DSA, TCD, electrocardiogram, EEG, etc.
(5) Blood test
Blood routine, biochemical examination.
The clinical manifestation is that the vertigo is intermittent and recurrent, with several days, months, and years. It often happens suddenly. At the beginning, the vertigo reaches the most serious degree. The head activity and the blinking are intensified. It is often accompanied by dumping. It is in a state of panic due to severe sense of rotation and movement. It is accompanied by tinnitus, deafness, nausea, vomiting, and complexion. Pale, slow pulse, decreased blood pressure and nystagmus. Each duration lasts from a few minutes to a few hours, and the individual is in a continuous state for several consecutive days. Tired and sleepy after each episode. Intermittent balance and hearing return to normal. After multiple episodes, vertigo is attenuated with the increase of deafness on the affected side, and vertigo disappears when it develops to complete deafness.
3, vertebral basilar artery VBA system ischemic lesions
There is nystagmus without other symptoms and signs of the nervous system. According to the clinical manifestations are divided into: 1 short-term ischemic episodes of seizures without timing, can be several times a day or a few days, usually a few minutes to half an hour to ease or disappear. The lighter ones are only dizzy and unstable, and the frequent episodes of severe cases progress to complete labyrinthine strokes. 2 After the onset of progressive stroke, dizziness, tinnitus, and deafness continued to progress, reaching a peak several days later. 3 hours after the onset of complete stroke, dizziness, instability, tinnitus, deafness peak, obvious nystagmus. Symptoms can be gradually reduced after a few weeks. Hearing disorder dizziness is often left.
There are other lesions that can cause dizziness, which are all areas of vertigo, such as: cerebellar hemorrhage, cervical lesions, intracranial tumors, craniocerebral trauma, drug or toxic poisoning, inflammatory demyelinating diseases.
Diagnosis
Diagnostic diagnosis of vertigo
Symptoms of vertigo and confusion:
Not biased to one side, no vertigo: There is a kind of dizziness, only dizziness, top-heavy, but also unstable, even falling, but not biased to one side, no clear surrounding environment or the sense of movement of its own rotation, nor There is nystagmus, called pseudo vertigo, or non-systemic vertigo.
The main symptom of benign paroxysmal positional vertigo is that you will feel dizzy or tilted and you are not turning or tilting. It happens when you move your head at a certain speed, such as flipping on a bed, turning your head quickly, bending over quickly, and quickly returning your head. Benign paroxysmal orthostatic vertigo often lasts for 1-2 minutes. It can be mild or severe, making you feel uncomfortable in the stomach and vomiting. Sometimes I find it difficult to stand or walk and lose balance.
Symptoms of orthostatic vertigo: The cervical vertebrae, thoracic vertebrae, and caudal vertebrae are a longitudinal axis of the body. The change in the position of the longitudinal axis. For example, getting up, lying down, turning over can cause dizziness.
Dizziness dominated by dizziness: Mainly feeling dizzy, feeling top-heavy.
Visual recognition disorder vertigo is a symptom of toxic vertigo. The patient often walks with a head straight and walks straight ahead, called visual recognition disorder vertigo.
Otogenic vertigo: refers to vertigo caused by abnormal vestibular vagus. When there is lost water (Ménière syndrome), motion sickness (sickness sickness), labyrinthitis, labyrinthine bleeding or poisoning, vestibular neuritis or damage, middle ear infections, etc. can cause postural balance disorders, vertigo. Because the vestibular nucleus is closely related to the nucleus of the oculomotor through the medial bundle, nystagmus often occurs when the current court is stimulated by pathology.
Eye-induced vertigo: non-motor illusion vertigo, mainly manifested as instability, increased when the eye is excessive, and relieved after closed eyes. Dizziness lasts for a short period of time. When you look at the moving objects, you will get worse. After you close your eyes, you will ease or disappear. Often accompanied by blurred vision, decreased vision or double vision. Visual acuity, fundus, and eye muscle function tests are often abnormal, and the nervous system has no abnormalities.
Senile vertigo usually manifests as dizziness, balance disorder and imbalance. When the patient blinks, he feels his own rotation and shaking, just like a car. Can not stand at the time of onset, accompanied by nausea, vomiting, tinnitus, sweating, bradycardia and decreased blood pressure and other symptoms of increased vagal tone, usually lasting for several minutes to several hours, sometimes up to several days, the vestibular system, visual system and location of the inner ear When the proprioceptor of the joint is transmitted into position and the signal of the vestibular ganglion is asymmetric, the control center located in the cerebellum and cerebral cortex can cause dizziness. Central vertigo can often occur ataxia, according to the symptoms can be judged at the site of the disease: corticospinal tract damage, can cause limb weakness or complete paralysis of the limbs and Babinsky sign positive, accompanied by rigidity and folding knife Sample.
Paroxysmal vertigo: is a common mechanical condition of the inner ear, accounting for about 20% of all vertigo, and is also the cause of about half of otogenic vertigo. Although the disease is an ear disease, it is often diagnosed in the first diagnosis of neurology, and many misdiagnosed as vertebrobasilar insufficiency, cervical vertigo and delayed treatment. Dizziness is a general term for dizziness and dizziness, glaring with vertigo, blurred vision and darkness. Rotate by the object, or if you turn around, you can't stand as a halo.
Rotational vertigo is caused by dysfunction of the vestibular nervous system and cerebellum. It is mainly caused by the feeling of dumping, and it feels its own shaking or the rotation of the scene.
Cervical vertigo refers to the qualitative or functional changes in the cervical vertebrae and related soft tissues (joint capsules, ligaments, nerves, blood vessels, muscles, etc.). During the examination, the frontal spinous process, the interspinous process, the transverse process, the paraspinal muscles, the lower part of the occipital trochanter, and the upper scapular area were tender, tense, hard or indurated. Even when the patient presses a certain part overnight, there may be dizziness and nystagmus or vertigo in the cervical vertebrae, and the head and neck movements are limited.
