Dizziness and vertigo are the most common clinical symptoms and are among the most frequently seen disorders in the internal medicine outpatient and emergency departments. In a study of dizziness in the community, 51% of people had monthly episodes of dizziness and 35% had daily episodes of dizziness.
The fact that people experience dizziness throughout their lives indicates that dizziness is commonplace. However, the diagnosis and understanding of dizziness and vertigo is not well understood by many physicians.
The most commonly used diagnoses for dizziness/vertigo symptoms are “cervical dizziness” or “cervical vertigo”, “cerebral insufficiency” or “vertebrobasilar insufficiency” , Meniere’s disease or Meniere’s syndrome, vestibular peripheral vertigo, even the patients themselves, as most doctors do, give themselves the diagnosis of cervical dizziness/vertigo (thought to be related to cervical spondylosis) or inadequate cerebral blood supply to the vertebral basilar artery (mistakenly thought to be arterial compression). And these diagnoses are far from the most common diagnoses of dizziness/vertigo abroad. For this reason, the author introduces the problems in the concept and diagnosis of dizziness and vertigo by combining the summary of his clinical practice and foreign experience.
I. Problems in the diagnosis of dizziness and vertigo
”Confusion”: Indeed certain dizziness is sometimes difficult to diagnose because of the patient’s unclear expression or the lack of relevant experience of the interrogator.
Arbitrary”: Clinical doctors give the diagnosis of “cerebral insufficiency of blood supply” or “cervical dizziness” to dizziness or vertigo of “unclear etiology” more arbitrarily. “or simply use the word “dizziness” to make a symptomatological diagnosis, instead of thinking deeply about the diagnosis of dizziness and vertigo.
For example, when a patient has dizziness or vertigo during head movement, the diagnosis often differs among physicians of different specialties, and some of them often diagnose it unilaterally based on their own opinion or from the perspective of their discipline.
Some physicians consider cervical dizziness or cervical vertigo simply because of the presence of osteophytes and narrowing of the spinal space as shown by cervical spine X-ray; some diagnose arterial stenosis or spasm as a result of insufficient blood supply to the brain based on transcranial Doppler ultrasound indicating rapid blood flow in a certain artery.
Some diagnose Meniere’s disease or vestibular peripheral vertigo directly based on simple vertigo; some physicians use the word “deficiency” as a generalized diagnosis. As a result, the same patient is given many different diagnoses and different treatment measures as if he or she were “blinded by the elephant”, and the patient has little effect, and some even aggravate the disease.
Some patients with conversion disorder type [hysteria] psychogenic dizziness are mistaken for cervical dizziness or cervical spondylosis and are treated with traditional orthopedic or acupuncture treatment, but they receive unexpected and immediate “miraculous” results, and the therapist still thinks it is the right treatment.
Some similar patients have even been administered cervical spine surgery and a difficult to say. Therefore, we should clarify the concept of dizziness and vertigo and master the characteristics of common dizziness and vertigo diseases to avoid blind diagnosis and treatment.
II. Correct understanding of the concepts of dizziness and vertigo
There are four types of dizziness as follows
1, dizziness (lightheadedness)
2, vertigo (vertigo)
3, balance instability (disquilibrium)
4, pre-syncope (presyncope)
Dizziness
It refers to paroxysmal or persistent brain unclearness, dizziness, head swelling, and tightness in the head. Hypertension and psychosomatic factors often cause dizziness. Dizziness may be a physiological process, not necessarily a pathological mechanism, such as lack of sleep, fatigue, long overnight shifts, etc., and can be corrected with timely adjustment.
Vertigo
It is a symptom that the subject has an illusion of motion with respect to static surrounding objects or his own position, and is mostly pathological. It is often manifested as a sense of rotation of visual objects or rotation of oneself, and may also have a sense of swaying instability, wave ups and downs, and falling. Vertigo often occurs in cases such as Meniere’s disease, vestibular disease, otoliths, vestibular migraine, and brainstem lesions. In vertigo, patients are usually afraid to open their eyes, often accompanied by nausea, and in severe cases, autonomic symptoms such as vomiting, excessive sweating, blood pressure fluctuations, etc. Some of them may be accompanied by nystagmus, ataxia and other neurological localization signs.
Pre-syncope state
Pre-syncope refers to the signs of chest tightness, palpitations, dizziness, blackness, and weakness that occur before syncope. If erectile dysregulation or upright hypotension occurs, the presyncope state is likely to occur.
Unstable balance
Dizziness is a symptom of unstable standing during movement or movement disorders, such as Parkinson’s disease, ataxia, and peripheral neuropathy.
C. Understanding the classification of dizziness
The classification of dizziness is generally based on two categories: non-vestibular dizziness and vestibular dizziness.
Non-vestibular system disease dizziness
Dizziness is mainly caused by medical system diseases [such as cardiovascular diseases (high and low blood pressure, heart rate disorders), blood diseases (anemia, erythrocytosis), endocrine diseases], environmental changes and excessive activities [heat, heat stroke, prolonged standing, overwork, etc.], mild post-traumatic head syndrome, visual fatigue and ocular myopathies (such as myasthenia gravis, glaucoma, etc.), inflammation of the five senses (oral cavity, paranasal sinusitis), upper sensation, and drug The effects of drugs or drug intoxication, etc. cause. It also includes psychogenic dizziness, such as depressive and anxiety states and hypomania.
Dizziness due to vestibular system disorders
It is divided into central and peripheral. Peripheral vestibular system disorders include benign episodic positional vertigo, Meniere’s disease, vestibular neuronitis, labyrinthitis, and lymphatic vessel leakage. Central vestibular system disease dizziness includes inadequate blood supply to the basilar artery, posterior circulation ischemia, cerebral hemorrhage, brain tumor, encephalitis or demyelinating disease, and vertiginous epilepsy. In some cases, there is both central and peripheral vestibular involvement, such as migraine vertigo (i.e., migraine isthmus) with central symptoms such as visual field loss and transient blurring of consciousness, and peripheral vestibular examination with unilateral hemiplegia in a few cases (the incidence varies from 8.1 to 23.8% in the literature), most of which can be recovered with time.