Vertigo is the most common clinical syndrome, and with the aging of the population, the incidence of this syndrome is increasing, and it has received widespread attention from the medical community both at home and abroad. Vertigo is the third most common symptom in outpatient clinics. What is vertigo? Vertigo is a general term for dizziness and lightheadedness. Vertigo is characterized by blurred vision, blurred vision and darkness, while dizziness is characterized by spinning vision or inability to stand up as if the sky is spinning.
1. Classification of vertigo: true vertigo and pseudovertigo
(1) True vertigo 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 site of damage. 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, which often recur. 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 cavernous disease and syphilis due to deep sensory disorders and motor dysfunctions.
(2) Pseudovertigo 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.
2. Medical history and clinical symptoms and signs
(1) The situation before the onset of vertigo. Whether there are factors such as excessive smoking and drinking, mental and emotional instability, fatigue and insomnia before the onset of vertigo.
(2) Situation of vertigo attack
① ② ③ ④ ⑤ ⑥ ⑦ ⑧ whether the attack occurs at night or in the morning, whether it occurs suddenly or slowly
(2) Whether it is the first or repeated attack;
③What kind of situation is the onset of vertigo, such as change of body position, neck twisting, or some special position?
④Whether the form of vertigo is rotational or non-rotational;
⑤ whether the intensity is tolerable and whether the consciousness is clear;
⑥Whether vertigo is reduced or increased when opening or closing the eyes, and whether vertigo is increased by sound and light stimulation or changing 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 shoulders and arms, numbness in the upper limbs, limited movement;
(5) Central nervous system symptoms: headache, impaired consciousness, sensorimotor disorders, speech or dysarthria, etc.
4. What tests should be done for vertigo? Vestibular function examination
(1) In-office or bedside vestibular function examination: including upright tilt test, in situ step test, neck twist test, etc;
(2) Nystagmus
(3) Nystagmography
(4) Balance posture chart, hearing function examination, imaging examination: cranial CT, MRI, etc. to clarify the presence of head occupancy, ischemic or hemorrhagic disorders.
Other medical examinations: blood pressure, electrocardiogram, biochemical examination, etc.
5. Common systemic diseases with vertigo
(1) Cerebrovascular vertigo: Sudden onset of severe rotational vertigo, which may be accompanied by nausea and vomiting, gradually decreasing after 10-20 days, mostly accompanied by tinnitus and deafness, but with clear consciousness.
(2) Cerebral tumor vertigo: Early on, mild vertigo is often seen, which can be swaying and unstable, while rotational vertigo is rare, often with unilateral tinnitus and deafness, etc. With the development of lesions, signs of adjacent brain nerve damage can appear, such as numbness and hypesthesia 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 it presents varicose 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, mostly confined to the parieto-occipital region, often with episodes of throbbing pain.
(4) Oculogenic vertigo: non-motor illusion vertigo, mainly manifested as unsteadiness, aggravated by excessive use of eyes, 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 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 an hour, and the symptoms are relieved or disappear after eating, often accompanied by fatigue, and the presence of hypoglycemia can be detected by checking blood sugar during the attack. Thyroid dysfunction can also lead to vertigo, and the diagnosis can be confirmed by clinical balance disorders and related tests of thyroid function.
(7) Vertigo caused by blood disorders: 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, palpitations, tinnitus, anxiety, dreaminess, inattention, memory loss, etc. There is no sense of rotation of external objects or rotation or swaying 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 pay attention to drink more water and not to change your position suddenly, such as getting up when going to the toilet at night, which can easily trigger 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: this kind of vertigo develops slowly and the initial symptoms are mild and not easy to detect. For mild vertigo that appears gradually, if it is accompanied by symptoms such as unilateral tinnitus and deafness, or other signs of adjacent brain nerve damage, such as numbness and hypoesthesia of the diseased side, peripheral facial palsy, etc., you should go to hospital as soon as possible for 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 cervicogenic vertigo. The treatment mostly adopts rehabilitation methods, such as cervical jaw pillow sling traction, Tui-Na manipulation treatment, acupuncture, etc., and serious cases need surgery.
(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 ophthalmological diseases, and the vertigo can be relieved naturally based on the recovery of the original disease.
(5) Neurofunctional vertigo: For vertigo caused by mental factors, firstly, patients should be relieved of anxiety and anxiety, and anti-anxiety or antidepressant drugs can be given appropriately, but sedative drugs should be avoided for a long time to avoid increasing the tolerance and dependence of drugs.
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. In addition, patients with vertigo should pay attention to the combination of work and rest, avoid strain, sleep enough, and avoid mood swings. Anxiety, irritation, tension, fear, anxiety, etc., may cause vertigo. During the period of vertigo, pay attention to a light diet, do not drink alcohol, rest in bed when vertigo attacks, and do not swing your head from side to side.