Cervicogenic vertigo is a common clinical condition, which can be caused by various factors such as vertebral artery, sympathetic nerve and proprioception.
1. Diagnosis is based on 1, the history of chronic neck pain before the onset of vertigo, which is common in middle-aged and elderly women.
2. Vertigo is the main symptom, with morning onset, and vertigo can be chronic and persistent or episodic intense vertigo. It is often associated with depression, fatigue, drowsiness, nausea and vomiting, tinnitus and deafness, and loss of vision. 3. Decreased mobility of the lower cervical spine and signs of misalignment and/or instability of the upper cervical spine, such as spine, articular and transverse process deviation and pressure pain, and spasm of the suboccipital muscles.
4, X-ray radiography: the lateral cervical spine film shows the change of physiological curvature of the cervical spine, narrowing of the intervertebral space; osteophytes and calcification of the horizontal ligament where the lesioned segment is located. On the orthopantomograph, sharpness and increased density of the hooks are seen; the vertebral body is tilted and rotated. The morphological changes of the intervertebral foramen and the reduction of the foraminal diameter can be seen in the oblique view.
5. If possible, the following tests can be performed: CT scan of the cervical spine can check the morphology and size of the transverse foramen and the presence or absence of intraforaminal bone redundancy, which can correctly determine whether there are compression factors in the transverse foramen of the vertebral artery; brain ultrasound (TCD) or digital subtraction vertebral arteriography (DSA) is of certain value for diagnosis; brainstem evoked potentials can help localize and qualitatively diagnose vertigo.
Chinese medicine symptoms: vertigo may be mild or severe, with headache, fatigue, laziness, mental depression, drowsiness or insomnia, palpitations and palpitations, dysarthria, pale or dull complexion. Pale purple tongue, or petechiae, weak or astringent pulse.
2. Phlegm clouding the clear orifices: dizziness and confusion, headache like a wrap, neck stagnation, unfavorable movement, throat choking, pangs of desire, chest tightness, gastric distention and fullness, loss of appetite, and unpleasant complexion. Pale tongue, white and greasy coating, smooth pulse.
3. Wind and Yang upheaval: intense vertigo, sudden fall, blurred vision, deafness, impatience and anger, soreness and weakness of waist and knees, soreness and pain of tendons and bones. Red tongue with little coating, and thin strings.
The onset and relief of vertigo are often related to the position of the neck. The vertigo is aggravated when the head is suddenly turned and stretched backwards, and can be reduced when the neutral position is restored. Physical examination may reveal a positive head-tilt test or head-turn test, and the results of vertebral artery ultrasound or cerebral ultrasound (TCD) have special diagnostic significance. Vertebral arteriogram or digital subtraction vertebral arteriogram (DSA) can help to confirm the diagnosis.
2. Sympathetic hyperactivity type: chronic vertigo is the clinical characteristic, the onset and aggravation of vertigo is not related to the head and neck posture; the face is pale and obscure, the tongue is purple and dark; often accompanied by palpitations and insomnia, depression and anxiety, headache and other neurological disorders. The skin of the occipital and parietal parts of the skull may be thickened with varying degrees of edema, and the TCD examination indicates spasm of the internal carotid artery system and/or vertebral system. Brainstem evoked potential examination may show mild mixed central and peripheral vertigo.
3. Cervical proprioceptive disorder: the degree is general, with chronic vertigo being the most common. The vertigo is aggravated in low head position or extreme posterior extension position, but can be reduced in neutral position. The suboccipital muscles are often tense, and moderate pressure on the suboccipital muscles can significantly relieve vertigo; sometimes signs of upper cervical dislocation can be seen; TCD and brainstem evoked potential examination are not positive.
4. Identification and treatment 1. Vertebral artery disorder type: Rolling and kneading on the back of the neck and shoulders, and then gently operating on the two temporal and forehead of the patient with one-finger Zen pushing method and fish interval kneading method to eliminate the head and facial symptoms. For those who have upper cervical spine misalignment signs, it is reasonable to use the adjustment of seated cervical spine rotation fine-tuning, extraction and extension of lower cervical spine rotation positioning trigger method to rectify.
2. Sympathetic hyperactivity type: roll and knead on the cervical collar, and operate on both sides of the anterior cervical trachea with light one-finger meditation push method or thumb flick method.
3. Cervical proprioceptive disorder type: Rolling and kneading method is applied to the back of the neck, shoulder and occipital area. For those who have signs of upper cervical dislocation, adjustment techniques such as seated cervical rotation fine-tuning, pulling and stretching down cervical rotation positioning trigger method can be reasonably used to rectify.
4. Other therapies.
a Guiding: mainly for functional exercise of cervical extensor muscle.
b Chinese herbal medicine: internal administration of blood-stasis activating herbal medicine, or intravenous drip.
C closure: cervical sympathetic ganglion closure, applicable to sympathetic hyperactivity type.
5. Precautions 1. Ophthalmogenic vertigo, otogenic vertigo and vertigo caused by intracranial lesions should be excluded before massage treatment.
2. It is recommended to inform patients of the possible hazards of certain techniques or treatments before treatment.
3. Avoid working or reading in a low position continuously for a long time, and promote intermittent cervical activities.
4. Pay attention to keeping the neck warm.
5. Ensure sufficient sleep time and quality every day.
Assessment of efficacy 1. Cure: vertigo disappears and the ability to work before onset is restored.
2. Improved: vertigo is relieved, occasional neck discomfort and vertigo are aggravated after exertion, and the quality of life and working ability are improved.
3. Not cured: vertigo does not improve significantly and seriously affects daily life and work.