Dizziness

Introduction 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.

Cause

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 occupying 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.

an examination

Related inspection

Thrombosis and hemostasis detection, Gunda's brainstem reflex, Gordon's examination, Dok sign

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.

Differential diagnosis

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.

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