1.What is the difference between vertigo and dizziness?
Vertigo is a kind of motion illusion, and there is no external stimulation during the attack. Vertigo itself is not an independent disease, there are dozens of diseases that can cause vertigo. Vertigo can be spinning, tumbling, swaying, tipping sensations, floating and bumping sensations, etc. These sensations are true vertigo and are generally associated with physiological and pathological stimulation of the vestibular system. Dizziness, sometimes referred to as lightheadedness, is a symptom of discomfort that occurs within the head and cannot be accurately expressed. It can be a mild feeling of instability, floating, or slight movement, and can be caused by dysfunction of the vestibular system or by disorders such as hypotension, cerebral ischemia, hypoglycemia, or anxiety.
Patients can make a preliminary judgment about their symptoms, whether it is vertigo or dizziness, and thus reduce the blindness of the consultation. If it is true vertigo, the patient should usually be seen in otolaryngology, while dizziness can be seen in otolaryngological diseases as well as internal diseases, neurological diseases, orthopedic diseases, brain surgery and psychiatry. If patients have difficulty in self-judgment, they can first consult a vertigo clinic and be judged by a vertigo specialist.
2.What types of vertigo are there according to the cause?
Depending on the location of the disease, vertigo is often divided into peripheral and central, with the former occurring more frequently. In daily practice, vertigo is often confined to a few vaguely recognized diseases, such as vertebrobasilar insufficiency, cervical spondylosis, Ménière’s disease and vestibular neuritis, or generally referred to as “vertigo syndrome”. In fact, peripheral vertigo accounts for 30%~50%, among which benign paroxysmal positional vertigo has the highest incidence, followed by Ménière’s disease and vestibular neuritis; central vertigo accounts for 20%~30%; dizziness associated with psychiatric and systemic diseases accounts for 15%~50% and 5%~30%, respectively; 15%~25% of vertigo has unknown causes.
3.Can you introduce several common diseases with vertigo as the main manifestation?
The most common ones are benign paroxysmal positional vertigo, which mainly manifests as follows
(1) The vertigo attacks are associated with changes in head position, such as when turning over in bed, or when getting up from doing housework or tying shoelaces. The vertigo usually lasts for less than 1min, and there are no symptoms of cochlear damage, i.e. no hearing loss or tinnitus.
(2) No positive neurological signs, i.e., no loss of consciousness, no hemiparesis, aphasia, hemianopia, etc. Dix-Hallpike and other examinations induce vertigo and groundward nystagmus.
Vestibular neuritis: is the result of viral infection of the vestibular nerve or vestibular neurons. Most patients have a history of upper respiratory tract infection or diarrhea in the days or weeks prior to the disease. Severe peripheral rotatory sensation often lasts more than 24h, sometimes for several days; accompanied by severe vomiting, palpitations, sweating and other autonomic responses. Most of them heal spontaneously within a few weeks, and recurrence is rare. More than half of the patients may develop transient instability within 1 year after the disease. There are no hearing changes.
Meniere’s disease: The etiology is not completely clear, and the pathological mechanism is mostly related to endolymphatic effusion. The main manifestations are recurrent vertigo, fluctuating hearing loss, dullness and tinnitus. Episodes usually last from tens of minutes to less than 24 hours, and intermittent periods may be without dizziness and with only poor hearing and tinnitus. Meniere’s disease cannot be diagnosed by a single attack and requires more than 2 follow-up visits.
Let’s talk more about central vertigo.
Transient ischemic attacks in the vertebrobasilar system: the symptoms are stereotypically recurrent and manifest as: vertigo lasting several minutes, total or partial presence of symptoms of damage to the cerebral nerves, brainstem, cerebellum or occipital lobe, no signs of neurological damage between attacks and no fresh infarct lesions on MRI scan. Ultrasound, TCD, CT angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) can determine the presence or absence of stenosis in the vertebrobasilar artery.
Vertebrobasilar artery insufficiency (VBI): There is a consensus that the diagnosis of VBI is currently too widespread. However, it is debatable whether this completely negates the name VBI.
Pontocerebellar horn tumor: Dizziness episodes are common, and signs such as cerebellar ataxia, lateral sensory deficits and abducens nerve palsy, and facial palsy are seen. Pathologically, they are commonly known as auditory neuroma, meningioma and cholesteatoma.
People often think that “cervical spondylosis” is the common cause of “dizziness”, but in fact, it is only one of the less common types of central vertigo. Cervical vertigo: There is no standardized criterion yet, but we tend to adopt the exclusion method. At least the following features should be present.
① Dizziness or vertigo accompanied by neck pain.
(2) Dizziness or vertigo mostly appears after neck activity.
③Some patients have positive neck distortion test.
④Abnormal neck imaging, such as cervical retroflexion, conus instability, disc herniation, etc.
⑤ Most of them have a history of neck trauma.
⑥Other causes are excluded.
4.How do patients with vertigo seek medical consultation?
Although the incidence of vertigo is high, patients’ descriptions of vertigo symptoms are usually unclear, and clinicians sometimes have difficulty classifying them. A patient’s complaint of vertigo may refer to balance disturbance, a feeling of instability, rotating vision, or dizziness. Many patients are often referred to many clinical departments and undergo numerous tests, but still cannot solve the problem. Due to the complexity of vertigo, in order to get a satisfactory diagnosis as soon as possible, you should first choose to visit a vertigo-specific clinic; or visit a neurology or otolaryngology department for the first time. When choosing otolaryngology for consultation, you should choose a doctor who specializes in otologic diseases.
The most common disorder of peripheral vertigo is benign paroxysmal positional vertigo, commonly known as otoliths. The main mechanism is an otolith located in the semicircular canal or the roof of the crest. It manifests as transient paroxysmal vertigo with horizontal or rotational nystagmus when the head position is moved rapidly to a specific position. It is often misdiagnosed as cervical spondylosis, cerebrovascular disease, or Meniere’s disease and wastes a lot of money on medical treatment with no benefit.
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