If a family member suffers from vertigo, especially when acute vertigo suddenly strikes, it is fierce, dizzy, nausea and vomiting, and painful. At this time, not only the patient himself is afraid, but also the family members are very nervous, thinking that they must have some serious disease. When this happens in the family, the first thing is to maintain a calm mood, do not be frazzled, do not know what to do. This not only increases the mental burden of the patient and worsens the symptoms, but also is very detrimental to the treatment of the disease. It is important to know that most of the diseases that cause acute attacks of vertigo are caused by peripheral lesions of the vestibular system, such as otoliths, Ménière’s disease, vestibular neuritis, etc. These diseases are mostly benign. These diseases are mostly benign and have a good prognosis, leaving no serious sequelae and no life threatening effects. So there is no need to panic too much. Of course, in this case, it is important to go to the hospital immediately to see the emergency room for a clear diagnosis. It is also necessary to consult a neurologist, because some life-threatening diseases such as cerebral infarction, cerebral hemorrhage and brain tumor can also cause acute attacks of vertigo. If you need to be hospitalized for observation, you should be hospitalized as soon as possible according to the doctor’s request to avoid delaying the condition.
Vertigo is a kinetic or positional illusion caused by the body’s impaired spatial orientation, and is multidisciplinary. The vast majority of people experience this disorder throughout their lives. According to statistics, vertigo accounts for 5% of outpatients in internal medicine and 15% of outpatients in otolaryngology. Vertigo can be divided into true vertigo and pseudovertigo. True vertigo is caused by diseases of the eye, proprioception or vestibular system, with a distinct sensation of external objects or self rotation. Pseudovertigo is mostly caused by systemic diseases, such as cardiovascular diseases, cerebrovascular diseases, anemia, uremia, drug intoxication, endocrine diseases and neurological disorders, and almost all of them have symptoms of dizziness of varying severity.
Clinical manifestations
1.Peripheral vertigo
Peripheral vertigo is caused by lesions in the vestibule or vestibular part of the inner ear, or in the extracranial segment of the vestibular nerve, including acute vaginitis and Meniere’s disease. Its characteristics are.
(i) vertigo is intense rotational, short duration, and the change of head position or body position can aggravate vertigo significantly.
(2) Nystagmus: nystagmus coexists with vertigo attack, mostly horizontal or horizontal plus rotational nystagmus. Usually there is no vertical nystagmus, the amplitude can be changed, and the nystagmus may subside or disappear after a few hours or days. Head position induced nystagmus is mostly fatigue, and temperature induced nystagmus is mostly seen in hemianopia.
(iii) Balance disorders: mostly rotational or up-and-down swaying motion sensation, unstable standing, spontaneous tilting, static upright test mostly tilting in the direction of the slow phase of nystagmus.
④Autonomic symptoms: such as nausea, vomiting, sweating and pallor, etc.
⑤ Often accompanied by tinnitus and hearing impairment without brain function damage.
2.Central vertigo
It refers to vertigo caused by lesions in the vestibular nucleus, brainstem, cerebellum and temporal lobe of the brain. Features.
(1) The degree of vertigo is relatively light, lasts long, is rotational or a sense of movement to one side, and can be reduced after closing the eyes, independent of head or body position changes. (2) The nystagmus is coarse and can be a single vertical nystagmus and/or horizontal or rotational type, and can persist for a long time with constant intensity. The direction of nystagmus is inconsistent with the side of the lesion, and the direction of spontaneous tilting and static upright test tilting is inconsistent.
(iii) Balance disturbance: it shows rotational or to one side motion sensation and unstable standing. Most of the vertigo and balance disturbance are inconsistent in degree.
④Autonomic symptoms are not as obvious as peripheral ones.
⑤No hemianopia, hearing impairment, etc.
⑥It may be accompanied by brain function damage, such as cerebral nerve damage, extraocular muscle paralysis, facial and tongue palsy, bulbar palsy, limb paralysis, high cranial pressure, etc.
Common diseases
1.Benign paroxysmal positional vertigo (otoliths)
Vertigo is most common in clinical practice and belongs to otorhinolaryngology, but most patients are often first seen in internal medicine. The manifestation of vertigo is related to the position of the head, with sudden onset and episodic vertigo. However, vertigo occurs when the head is in a certain position and can last for tens of seconds, and it can be reduced or disappeared when the head is turned or reversed. The duration of vertigo varies greatly, and most of them resolve themselves or disappear within a few hours or days after the onset.
2. Meniere’s disease
The clinical manifestation of Meniere’s disease is intermittent recurrent attacks of vertigo, with intervals ranging from days, months to years. The vertigo is often sudden, starts with the most severe degree, intensifies with head movement and eye opening, and is mostly accompanied by tilting, panic due to the feeling of violent rotation and movement, accompanied by tinnitus, deafness, nausea, vomiting, pallor, slow pulse, drop in blood pressure and nystagmus. The duration of each attack varies from a few minutes to several hours, with some attacks lasting for several days. After each episode, fatigue and sleepiness are present. Balance and hearing return to normal during the interval. After several attacks, the vertigo decreases as the deafness on the affected side increases, and disappears when the deafness progresses to complete deafness.
3. Ischemic lesions of the VBA system of the vertebral basilar artery
There is nystagmus without other signs and symptoms of the nervous system. They are classified according to clinical manifestations as follows
(1) Transient ischemic attack type The attacks are indefinite and may occur several times in a day or once in several days, and usually resolve or disappear in a few minutes to half an hour. In mild cases, there is only vertigo and instability, but in severe cases, frequent attacks progress to complete vagal stroke.
(2) Progressive stroke medium The vertigo, tinnitus and deafness continue to progress and worsen after the onset of stroke, reaching a peak after a few days.
(3) Complete stroke: Vertigo, instability, tinnitus, and deafness peak a few hours after onset, and nystagmus is apparent. The symptoms may gradually decrease after a few weeks. Dizziness is often associated with hearing impairment.
There are other pathologies that can also cause vertigo, all of which fall under the category of vertigo, such as: vestibular neuritis, vestibular migraine, sudden deafness, cerebellar hemorrhage, cervical lesions, intracranial tumors, craniocerebral trauma, drug or toxic poisoning, inflammatory demyelinating diseases, etc.
The tests that are often done when patients with vertigo visit the clinic are: external auditory canal examination, vestibular function examination, hearing examination, VNG, cranial CT, CTA, brain MRI, DSA, TCD, etc.