Vertigo is the most common clinical syndrome, and with the aging of the population, the incidence of this syndrome is increasing and is receiving widespread attention from the medical community both at home and abroad.Smith (1993) reported that vertigo is the third most common symptom in outpatient clinics. It involves multiple disciplines and is experienced by the majority of people throughout their lives. According to statistics, vertigo accounts for 5% of outpatients in internal medicine and 15% of outpatients in otolaryngology. Elderly people living at home have vertigo 50-60% of the time, accounting for 81-91% of geriatric outpatient visits; among them, the incidence of vertigo in people over 65 years of age is 57% for women and 39% for men.
What is vertigo?
Vertigo is a general term for dizziness and lightheadedness. Vertigo is characterized by blurred vision, blurred vision and darkness, and vertigo is characterized by spinning vision or inability to stand up.
Classification of vertigo: true vertigo and pseudovertigo
1.True vertigo
It is caused by diseases of the eye, proprioception or vestibular system, and there is a clear sense of external objects or self rotation. It can be divided into ophthalmic, proprioceptive disorders and vestibular vertigo depending on the damaged area.
Most of the vertigo caused by vestibular system disorders have more severe symptoms, such as Meniere’s syndrome, inadequate blood supply to the vertebral basilar artery, and brainstem infarction, and often have recurrent attacks.
Ocular vertigo can be either physiological or pathological. For example, if you stare out of the window for a long time on a train, you can experience vertigo and railroad nystagmus; if you look down at the rapidly passing water under your feet on a high bridge, you can feel yourself moving in reverse and vertigo.
These are all physiological vertigo induced by visual and optokinetic stimuli, and the symptoms will disappear when removed from the environment. Diseases of the eye, such as acute ocular muscle palsy, can cause diplopia and vertigo.
Vertigo caused by proprioceptive disorders is called postural sensory vertigo and is seen in patients with spinal cavitation and syphilis due to deep sensory disorders and motor dysfunctions.
2.Pseudovertigo
It refers to vertigo caused by systemic diseases, such as cardiovascular disease, cerebrovascular disease, anemia, uremia, drug poisoning, endocrine disease and neurosis, etc. Almost all of them have symptoms of dizziness of varying severity, and patients feel “floating” without a clear sense of rotation.
Medical history and clinical signs and symptoms
1.The situation before vertigo attack
Before the attack, there were no factors such as excessive smoking and drinking, mental and emotional instability, fatigue and insomnia.
2.Situation of vertigo attack
(1) Whether the attack occurs at night or in the morning, sudden or slow onset;
(2) First attack or repeated attacks;
(3) What kind of condition is the onset of vertigo, such as change of body position, neck twisting, or some special position;
(4) Whether the form of vertigo is rotational or non-rotational;
(5) Whether the intensity is tolerable and whether the consciousness is clear;
(6) Whether the vertigo is reduced or increased when opening or closing the eyes, and whether the vertigo is increased by sound and light stimulation or changing the position.
3.Symptoms associated with vertigo
(1) Autonomic symptoms: change in blood pressure, sweating, pale face, diarrhea;
(2) Ear symptoms: deafness, tinnitus, stuffy ears;
(3) Eye symptoms: darkness in front of the eyes, double vision, blurred vision;
(4) Neck symptoms: pain in the neck or shoulder and arm, numbness in the upper limbs, and limited movement;
(5) Central nervous system symptoms: headache, impaired consciousness, sensorimotor disorders, speech or dysarthria, etc.
What tests should be done for vertigo?
Vestibular function tests.
(1) In-office or bedside vestibular function tests: including upright tilt test, in situ step test, neck twist test, etc;
(2)Nystagmus
(3)Nystagmography
(4)Balance posture chart
Hearing function examination.
Imaging examinations: cranial CT, MRI, etc. to clarify the presence of head occupancy, ischemic or hemorrhagic disorders.
Other medical examinations: blood pressure, electrocardiogram, biochemical examination, etc.
Various common systemic diseases with vertigo
1. Cerebrovascular vertigo: Sudden onset of severe rotational vertigo, which may be accompanied by nausea and vomiting, gradually reduced after 10-20 days, mostly accompanied by tinnitus and deafness, but with clear mind.
2.Brain tumor vertigo: Early on, mild vertigo is often seen, which can be a sense of swaying and instability, while rotational vertigo is rare, often with unilateral tinnitus and deafness, etc. With the development of lesion, signs of adjacent brain nerve damage can appear, such as numbness and sensory loss of the diseased side, peripheral facial palsy, etc.
3. Cervicogenic vertigo: It is manifested as various forms of vertigo, with dizziness, swaying, unsteadiness, floating sensation and other sensations. The vertigo is recurrent, and its occurrence is obviously related to sudden head rotation, i.e., it occurs mostly during neck movement, and sometimes presents variable vertigo when sitting up or lying down. The episodes are usually brief, ranging from a few seconds to a few minutes, but there are cases of longer duration. Pain in the neck or posterior occipital region may occur in the morning. Some patients may have symptoms of cervical nerve root compression, i.e. numbness and weakness in the arms, and involuntary falling of objects held. More than half of the patients may have tinnitus, and 62-84% of the patients have headache, which is mostly confined to the parieto-occipital region, often in the form of episodic throbbing pain.
4. Oculogenic vertigo: non-motor illusion vertigo, mainly manifested as a feeling of instability, which is aggravated when using eyes excessively and reduced after resting with eyes closed. The vertigo lasts for a short period of time and is aggravated when the eyes are opened to look at external moving objects, and is relieved or disappears when the eyes are closed. It is often accompanied by blurred vision, loss of vision or diplopia. Visual acuity, fundus and ocular muscle function examination are often abnormal, and there is no abnormal performance of the nervous system.
5.Cardiovascular vertigo: vertigo caused by hypertension can be clearly diagnosed by blood pressure measurement. Carotid sinus syndrome can lead to episodes of vertigo or syncope. Most of the onset triggers are factors that suddenly cause pressure on the carotid artery, such as sharp neck turn, low head, tight collar, etc.
6.Endocrine vertigo: Hypoglycemic vertigo often occurs before hunger or eating and lasts for tens of minutes to one hour, and the symptoms are relieved or disappear after eating, often accompanied by fatigue, and the presence of hypoglycemia can be found when checking blood sugar during the attack. Thyroid dysfunction can also lead to vertigo, with clinical balance disorder as the main cause, and relevant examination of thyroid function can confirm the diagnosis.
7. Vertigo caused by blood diseases: leukemia, pernicious anemia and blood hypercoagulable diseases can cause vertigo, and the diagnosis can be confirmed by blood system examination.
8.Neurological vertigo: The patient’s symptoms are diverse, and the dizziness is mostly pseudo-vertigo, often accompanied by headache, head swelling, heaviness, or a variety of neurological manifestations such as insomnia, palpitation, tinnitus, anxiety, dreaminess, inattention, memory loss, etc. There is no sense of rotation of external objects or rotation or shaking of oneself. For women over 45 years old, attention should also be paid to differentiate it from menopausal syndrome.
Prevention and treatment of vertigo
Patients suffering from vertigo should be accompanied by family members when they go out to prevent accidents.
1. Cerebrovascular vertigo: Due to the increase of blood viscosity in summer and winter, various cerebrovascular accidents are likely to occur, leading to the occurrence of cerebrovascular vertigo. You should be careful to drink more water and not to change your position suddenly, such as getting up when you go to the toilet at night, which can easily cause cerebrovascular vertigo. Once it happens, you should go to the hospital as soon as possible, and after the diagnosis is confirmed, you can give appropriate vasodilator drugs, anti-platelet aggregation drugs (such as aspirin), anticoagulant drugs, etc.
2.Brain tumor vertigo: The onset of this kind of vertigo is slow and the initial symptoms are mild and not easy to detect. For mild vertigo that appears gradually, if it is accompanied by unilateral tinnitus, deafness and other symptoms of adjacent brain nerve damage, such as numbness and sensory loss on the side of the patient, peripheral facial palsy, etc., you should go to the hospital as soon as possible to get a clear diagnosis and early surgical treatment.
3. Cervicogenic vertigo: Pay attention to the usual work and study position, and move the neck properly after long hours of ambulatory work. The height of pillow should be appropriate, and the pillow should not be padded too high to cause the occurrence of cervicogenic vertigo. Treatment mostly adopts rehabilitation methods, such as cervical jaw pillow sling traction, Tuina manipulation treatment, acupuncture, etc. Serious cases need surgical treatment.
4.For vertigo caused by other diseases, such as endocrine vertigo, hypertensive vertigo and ophthalmogenic vertigo, the original disease should be actively treated, such as controlling blood pressure and treating ophthalmic diseases, so that the vertigo can be relieved naturally based on the recovery of the original disease.
5. Neurofunctional vertigo: For vertigo caused by mental factors, first of all, patients should be relieved of anxiety and anxiety, and anti-anxiety or antidepressant drugs should be given appropriately, but sedative drugs should be avoided for a long time to avoid increasing the tolerance and dependence of drugs.
Conclusion
The clinical manifestations of vertigo are complex and diverse, involving many disciplines and dozens of diseases. Patients should actively prevent and control the primary disease; once the symptoms appear they should go to the hospital as soon as possible to avoid delaying the disease.