According to statistics, the prevalence of dizziness in the population is about 5%, accounting for 15% of outpatients, and it is more common in elderly outpatient clinics, reaching 81-91%.
Dizziness was first described in the Nei Jing as “vertigo” and is believed by Chinese medicine to be related to deficiency of the medulla oblongata, blood deficiency and evil in the middle. In fact, dizziness is only a symptom with complex causes, like coughing, sneezing, or headache, and not a specific disease, but there must be some underlying disease behind it. There are many causes of dizziness, and it is still a difficult clinical condition to find the cause of dizziness, which is sometimes very difficult and often even makes doctors feel “dizzy”. Some dizziness is not serious, such as dizziness when hungry, when riding in a car or when overexerted, these mild, physiological dizziness, there is no need to fear, after a period of rest and replenishment, will naturally recover, but some dizziness can not be ignored.
What is dizziness?
There are two similar concepts about dizziness, one is dizziness and the other is vertigo, both of which sound similar, but in fact their performance and causes are very different.
Dizziness is an illusion or hallucination of a change in the spatial position of oneself and surrounding objects, including a sense of rotation, bumps, oscillation, floating or drifting, and may be accompanied by significant nausea and vomiting, fear of opening the eyes, and panic and sweating. Vertigo is often a symptom caused by a peripheral or central vestibular system lesion.
In contrast, dizziness is only a persistent sense of mental fogginess and lack of clarity, and may be accompanied by feelings of head heaviness, stuffiness, and swelling. Dizziness is often not a problem of the vestibular system, but can be caused by low cranial pressure syndrome, anemia, hypertension, postural hypotension, heart disease, cardiac arrhythmias, ophthalmologic disease, psychiatric disorders (depression, anxiety), insomnia, and other causes.
Why do people feel dizzy?
Why don’t people hit a wall or a tree? How do you know that reaching for an object will be so accurate that you won’t reach farther or closer and not get it? When someone pushes you, your body just tilts a little and then quickly corrects itself? This is all due to the balance triad.
The synergy of the visual, proprioceptive and vestibular systems allows the body to maintain its balance and normalize its orientation, which is called the “balance triad”. The vestibular system is the most important in maintaining the balance of the body’s posture and position. It is also the most closely related to vertigo. Under normal conditions, the activity of the vestibular system in coordinating the body’s balance is rarely perceived, but when the vestibular system is subjected to strong stimulation or pathological damage, the vestibular system can be affected.
However, when the vestibular system is more strongly stimulated or pathologically damaged, the vestibular sensory stimuli do not coincide with the impulses from muscles, joints and visual receptors in spatial orientation, and vertigo is produced.
The vestibular system consists of the inner ear, the vestibular nerve, the vestibular nucleus and the vestibular center. Vertigo caused by lesions of the inner ear or vestibular nerve is called peripheral vertigo, while vertigo caused by lesions of the vestibular nucleus or vestibular center is called central vertigo.
Peripheral vertigo
1.Benign paroxysmal positional vertigo
It is the most common type of peripheral vertigo (50%), also known as otoliths, and is characterized by brief episodes of vertigo when the head position changes, lasting only a few seconds to 20 seconds,
The duration of vertigo is only a few seconds-20 seconds, but rarely >40 seconds; vertigo is easily fatigable and self-resolving.
2.Ménière’s disease
Meniere’s disease is also called Meniere’s disease.
It was first reported by French physician Meniere in 1861, so it is named after him. It is an idiopathic inner ear disease with typical symptoms of recurrent rotational vertigo, fluctuating sensorineural hearing loss, tinnitus and fullness in the ear. It occurs between 30 and 40 years of age and has a genetic predisposition. The basic pathological change is fluid in the membranous vagus, so some people call it “inner ear fluid” or “inner ear glaucoma”. The vertigo lasts for more than 20 minutes and usually resolves within 24 hours, but the hearing will gradually deteriorate with repeated attacks.
3.Vestibular neuritis
It is a common disease of the vestibular system, second only to benign paroxysmal positional vertigo and Meniere’s disease in terms of incidence. It is common in adults but rare in children, and its cause may be related to viral infection. It presents as sudden onset vertigo, usually without tinnitus or hearing impairment. It has a tendency to heal on its own.
4.Vestibular drug toxicity
The adverse effects of many drugs can be vertigo, the most studied are aminoglycosides and diuretics, and some other drugs, such as anticonvulsant drugs, morphine derivatives, anti-phobia and narcotic drugs, have different degrees of inhibitory effects on the vestibule.
5.Sudden deafness
Sudden deafness is a kind of sudden sensorineural deafness of unknown cause, also called violent deafness. 10 people out of 10,000 have the disease, and the incidence increases gradually with age, and 3/4 of people aged 40 or above are affected. Its onset is rapid and progresses quickly, and the treatment effect is directly related to the time of consultation, so it should be regarded as an emergency after occurrence and immediately go to the hospital.
6. Other diseases in peripheral vertigo
Foreign body or cerumen embolism in external auditory canal, otitis media, tympanic pneumatic injury, middle ear and mastoid tumor, otosclerosis, recurrent vestibular disease, autoimmune inner ear disease, delayed membranous vagal effusion, vagal trauma, vagal hemorrhage, temporal bone fracture, etc.
Central vertigo
Central vertigo is vertigo caused by lesions in the vestibular center and accounts for about 5 to 10% of all vertigo. Although the percentage is not high, its severity has to be alarming. In addition to dizziness, it is often accompanied by double vision, slurred speech, dysphagia and ataxia. The causes of central vertigo include cerebrovascular disease, cerebellar tumors, IV ventricular tumors, intracranial infections and other diseases, among which the symptoms caused by cerebrovascular disease are the most common and deserve the most attention, such as vertebrobasilar stenosis or cerebellar and brainstem infarction, mainly because it occurs quickly and deteriorates quickly; if not treated in time, it is likely to further aggravate and endanger life, therefore, when vertigo and the above symptoms occur It is important to go to a regular hospital with a neurological specialist for medical examination as soon as possible.
What should I do in case of dizziness?
When dizziness occurs suddenly, you should take a safe position immediately to prevent bruises. Since dizziness is only a symptom and there are many causes of dizziness, it can be a “minor problem” or a manifestation of a serious disease, so you should not take it lightly. The cause of vertigo should be clarified. Avoid misdiagnosis and mistreatment.
Before finding out the cause, you should not purchase drugs, blindly infuse fluids or traction/massage the neck to avoid misdiagnosis.