senile vertigo
Introduction
Introduction 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.
Cause
Cause
Etiology characteristics:
1. Degenerative changes in the vestibular system
Degenerative changes in senile tissue can occur on either or both sides of the vestibular system. Studies have shown that the vestibular system of the elderly can have degeneration of the otolith, ampullary ridge and cystic epithelium, rupture of the balloon membrane, and reduction of cystic hair cells. 20%, ampullary ridge hair cells decreased by 40%, endolymphatic and endolymphatic wall calcium deposition and glassy stool, vestibular central nervous system decreased and a series of lesions. Due to the asymmetry of the incoming information, the vestibular center cannot be analyzed correctly and there is dizziness or dizziness.
2, multiple system lesions
The balance of the body is maintained by the coordination of the visual system, the proprioceptive system and the vestibular system. The vestibular system is the most important, but the signal of the visual system is not symmetric or the cerebrovascular disease is located at the large joint due to the inconsistent refractive error of both eyes. The signal asymmetry of the afferent central system of the proprioceptive system can cause different degrees of dizziness in elderly patients. Therefore, it can also be said that dizziness is also a manifestation of the disorder of the organic balance system of vision, proprioceptors and vestibular system in the body.
3, central vertigo more than peripheral vertigo
About half of senile vertigo is a central disease, and 1/4 is a peripheral lesion, which is characterized by vestibular hair cells and vestibular ganglion cell degeneration. Some 64 patients with senile vertigo have been analyzed, of which 36% are brain lesions. Weekly lesions were 35%, vestibular central lesions were 13%, brainstem ischemia was 2%, and others accounted for 14%. Among the adult populations, the most common vertigo occurred in the benign position of paroxysmal vertigo (34.3%), followed by central vestibular vertigo (7.7%) and Meniere's disease (6.6%).
Examine
an examination
Related inspection
Cranial CT examination of nystagmus electrograms
(1) Whole body examination: Focus on the eye, neck, circulatory system and nervous system that can cause dizziness.
(2) ENT examination: focus on the middle ear, inner ear with or without inflammatory disease.
(3) Audiological examination: tuning fork experiment, pure tone side listening, language audiometry, acoustic impedance test, cochlear dot map and auditory brainstem response (ABR).
(4) vestibular function examination: spontaneous nystagmus, gait test, position experiment. The nystagmus (double temperature test) and the rotational test can be used to understand the amount and nature of vestibular function loss. The slow phase rate, frequency amplitude and eye vibration value of the elderly nystagmus are gradually weakened. The cold stimulation reaction is small, and the above parameters are weakened by the heat stimulation reaction.
(5) Imaging examination: ear X-ray filming, ear and cervical vertebra photography, thin layer or skull of the humerus (CT scan, skull or cervical magnetic resonance, transcranial color Doppler, to understand the internal auditory canal, cranial Internal and cervical conditions.
(6) Laboratory examination: EEG, electrocardiogram, radionuclide examination, blood rheology, blood biochemistry and allergy examination, to understand brain, heart, liver, kidney function and immune function.
Diagnosis
Differential diagnosis
Diagnosis is the most basic element of no diagnosis: vertigo type, duration, intensity, accompanying symptoms.
1. Analysis of medical history:
(1) According to the manifestation of vertigo, single or multiple episodes, whether accompanied by symptoms of the cranial nerves of the cochlear symptoms, etc., whether the vestibular or non-vestibular, whether the vestibular is the central or periodic.
(2) History of heart, cerebrovascular disease and hyperlipidemia is an important cause of senile vertigo.
(3) Metabolic diseases (diabetes), endocrine diseases (such as hyperthyroidism, hypothyroidism) and other systemic history.
(4) History of ear drug poisoning, history of ear surgery, history of head trauma and history of respiratory virus infection can rule out the causes of common peripheral vertigo.
2, accompanying symptoms
(1) nystagmus: It is the most common accompanying symptom of vertigo, and has important significance for the diagnosis and differential diagnosis of vertigo.
Peripheral nystagmus: Conjugated levels, etc. or horizontal-rotating, most prominent toward a diseased labyrinth, whose rapid motor component is from the diseased side to the healthy side.
Central nystagmus: It can be horizontal or vertical, and its fast component has the same direction as the gaze direction, and can be either on one side, or it can be oscillating or the two eyes are not synchronized. Significant rotatory nystagmus, ocular tremor without a certain direction caused by upward or downward gaze, mostly caused by central nervous system lesions.
(2) Ataxia: The coordination of voluntary movements that maintain balance is poor. 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. Basal lesions (palm, caudate nucleus, putamen, substantia nigra or extrapyramidal system) do not cause changes in exercise weakness and tendon reflexes, which are characterized by involuntary movements, which can be manifested as increased exercise, lack of posture or changes in posture and muscle tone. Cerebellar diseases can affect the range of motion, rhythm and strength, and the table shows various abnormalities, but has less effect on muscle strength.
(3) Deafness: Transmitted deafness: the gas conduction hearing threshold is increased and the bone conduction hearing threshold is normal. Sensorineural deafness: The gas and bone conduction thresholds are abnormal. Central deafness: The lesion is above the cochlear nucleus, and the threshold of gas and bone conduction is increased.
