Vertigo is a very common clinical symptom, and I believe we have all experienced it to a greater or lesser extent, or have seen loved ones or friends around us who have had this painful experience. Our purpose of studying it today is not to let you learn the diagnosis and treatment of vertigo like a doctor, but to help you solve the following problems.
I. What is vertigo?
There are several concepts that need to be clarified here.
Vertigo: refers to the sense of rotation and oscillation of oneself or the environment, and is a kind of motion illusion. Or, vertigo refers to the rotation of the vision, the eyes are golden stars; dizziness refers to the unstable standing, such as sitting in a boat.
Dizziness: refers to a sense of instability in oneself.
Dizziness: refers to the feeling of unclearness of the mind, and it is not what we will discuss this time.
The pathogenesis of vertigo and dizziness are not quite the same, but sometimes they are two manifestations of the same disease at different times.
Second, which department should I go to if I have vertigo?
First, let’s briefly explain the mechanism of vertigo. The mechanism of vertigo formation is very complex, so we will explain it in the simplest and most programmatic way. There are two major organs of balance in the human body, one in the ear, called the semicircular canal, and one in the brain, the vestibular nucleus located in the brainstem and the system connected to it. We call the lesions of the semicircular canal in the ear peripheral vertigo and the lesions of the vestibular nucleus system in the brain central vertigo.
The difference between peripheral vertigo and central vertigo in terms of clinical symptoms is that peripheral vertigo is often accompanied by tinnitus because it is a lesion in the ear, while central vertigo is rarely accompanied by tinnitus because it is a lesion in the brain. In the case of peripheral vertigo, the patient should be seen in the department of otolaryngology, while in the case of central vertigo, the patient should be seen in the department of neurology or encephalopathy. Whether vertigo is accompanied by tinnitus is one way to help us choose the department to see, but it is not absolute. There is a test called “nystagmography” that can help us to identify which kind of vertigo is present.
What are the main diseases of vertigo?
Peripheral vertigo accounts for about half of the cases and is the most common. Common diseases include Meniere’s disease, benign positional vertigo, vestibular neuronitis, etc. These diseases can be very serious or even life threatening. But basically, it is a localized lesion in the ear, which has less impact on the whole body and is not life-threatening, and will be cured or relieved by treatment.
Central vertigo, which accounts for about 30% of the cases, is more complicated and the lesions are usually in the brain, so it is important to pay attention to it. Today we would like to focus on two diseases of central vertigo.
1. Posterior cerebral circulation ischemia: As you know, there are four arteries supplying blood to the brain, the left and right carotid arteries and the left and right vertebral arteries. The carotid artery system supplies blood to the front two-thirds of the brain, which is called the anterior circulation, and the vertebral artery system supplies blood to the back one-third of the brain and the brainstem and cerebellum, which is called the posterior circulation. Of course there is a traffic artery connection between the two, which can support each other. Due to the different division of labor in the brain, when there is ischemia and infarction or hemorrhage in the anterior circulation, the most common symptoms are paralysis of the limbs and speech impairment, while the most common symptom in the posterior circulation is vertigo when there is ischemia, and once a larger infarction or hemorrhage occurs, it is immediately life-threatening and even too late to rescue. So for posterior circulation ischemia what kind of people are prone to get posterior circulation ischemia? Generally, they are middle-aged or older, with unhealthy lifestyle (poor diet, smoking, lack of activity, etc.), obesity and multiple vascular risk factors, including hypertension, diabetes, hyperlipidemia, heart disease, previous history of stroke, etc.
In people with these disease backgrounds, once recurrent episodes of dizziness, vertigo, and symptoms such as numbness of limbs or head and face, weakness of limbs, uncoordinated movements, hoarseness or difficulty in swallowing, falls, and visual deficits occur, it is a sign of posterior cerebral circulation ischemia. At this time, we call this vertigo a signal symptom of cerebral ischemia, which is considered by Chinese medicine as a precursor symptom of stroke, or even a mini-stroke. Catching treatment at this stage can prevent more serious conditions from happening. Therefore, for people above middle age, dizziness and vertigo is a symptom that should not be neglected, and it is often not very serious, sometimes it comes on and sometimes it goes off, it is more common to feel dizzy and walk unsteadily, it is accompanied by nausea but less vomiting, it is usually not accompanied by tinnitus, other symptoms can be less obvious, and some people will miss the consultation for various reasons. Even many people, because they don’t pay attention to their health in general, find out that they have basic diseases such as hypertension and diabetes only after they develop vertigo, and due to long-term neglect, they become atherosclerosis and obstruction. Therefore, patients with some of the underlying diseases mentioned earlier should go to the hospital immediately. This is also the stage of “treating the disease before it happens” in Chinese medicine, which is called “preventing the disease before it happens”.
When posterior circulation ischemia occurs, the primary disease is often not well controlled, such as high blood pressure, high blood sugar, poor heart function, etc. Doctors will first control the primary disease, and at the same time take some emergency measures, such as: dilating cerebral blood vessels, improving cerebral circulation, nourishing brain cells, etc., to resolve a “crisis” of cerebral blood supply. A posterior circulation ischemic vertigo. After the “crisis” has passed, it is a lifelong task for these patients to actively control the primary disease, ensure the long-term blood supply to the brain, and ensure the normal brain function according to the accepted medical program. In the sense of stroke prevention, this is called “prevention before the disease” and is a long-term task of “treating the disease before it occurs”.
There are several well-known doctrines in Chinese medicine regarding the understanding of vertigo. For example, “no phlegm does not make vertigo” and “no deficiency does not make vertigo”. For posterior circulation ischemia, there are two principles that are unanimous in Chinese medicine: one is “treat the symptoms if it is urgent, and treat the root cause if it is slow”, and the other is that vertigo is caused by phlegm and stasis together. Therefore, during the remission period, the treatment should be to supplement the deficiency or to supplement the deficiency and diarrhea at the same time, while during the dizziness attack, the main treatment should be to treat the phlegm and stasis together. It has been clinically applied for 20 years, and it has been proved by isotope tracing method at Kyoto University in Japan that it can improve cerebral blood flow in cerebral infarction animals.
2. Cervical vertigo: Since the blood supplying the posterior circulation goes up from the transverse foramen of the cervical spine into the brain, people with cervical spondylosis can also experience central vertigo. This is more common in people over middle age and will often be one of the various primary conditions we mentioned above, which act in conjunction with other factors to cause ischemia in the posterior circulation. Treatment must be developed with a multi-session modulation program, which we will not go into here.
Our special emphasis today is on the occurrence of cervical vertigo in adolescents. Originally, cervical spondylosis is a group of neurological syndromes caused by degenerative changes of the cervical intervertebral discs, and it is generally believed in textbooks that degenerative changes of the intervertebral discs start at the age of 35. However, due to the change of lifestyle and social competition, cervical spondylosis has become a common disease among adolescents. Recently, a survey of 2,000 cervical spondylosis patients found that adolescent patients accounted for 12% of the patients, and 87% of them were accompanied by cerebrovascular spasm. In this group of adolescent patients, the youngest was only 9 years old, and one child developed cervical osteophytes at the age of 12, while the majority of patients were concentrated in the age groups of 12-13 and 16-18. This is the period when students move from elementary school to middle school and middle school to high school. High school students are the most stressful period of their youth, including both mental and physical stress. In the current social environment where it is proposed that life cannot be lost at the starting line, by high school, the child’s body and mind have already gone through about 10 years of continuous high pressure and illnesses have become apparent. High school is an important sprint stage of life, and cervical spondylosis can greatly affect the physical and mental health of children. Most patients have symptoms such as dizziness, vertigo, nausea, headache, loss of vision and neck discomfort, and a few have symptoms such as numbness in the arms, chest tightness, breath-holding, tinnitus and weakness in the lower limbs. I have encountered too many such patients in my clinical practice. Some time ago, there was talk of including cervical spondylosis in the scope of white-collar occupational diseases, which would mean that the state would be responsible for the treatment of this disease if it entered the scope of occupational diseases. And now teenagers who grow up and want to enter the white-collar class have cervical spondylosis before they are mature.
The causes of cervical spondylosis in adolescents are
(1) Traumatic factors.
(2) intrinsic factors: adolescents due to poor posture, weakness, back overload can cause cervical spine joint dislocation, did not cause enough attention, and because of the long course of cervical spondylosis, easy to recur, the condition is sometimes light, many adolescents will then appear tension, anxiety, fear and other emotions. In addition, long-term suppressed feelings, sentimental people are prone to neurasthenia, which will affect the bones and joints and muscle rest, in the long run, the neck and shoulders are prone to pain, and neck and shoulder pain discomfort will affect the study work of adolescents.
The analysis of 500 cases of cervical spine physiological curvature survey on adolescents shows that 417 people with abnormal cervical spine physiological curvature account for 83.4%, of which 189 people with straightened cervical spine physiological curvature account for 37.8% and 228 people with cervical spine physiological curvature hyperbolic account for 45.6%.
Hazards of cervical spondylosis in adolescents.
1, muscle spasm, scalp pull, nerve irritation can cause neuritis, involvement headache, seriously affecting learning efficiency.
2, neck, shoulder and back pain and discomfort, cervical spine straightening, reversion caused by changes in the curvature of the thoracic and lumbar vertebrae, which in turn causes generalized soreness and weakness.
3, cervical spine curvature changes cause chronic blood supply deficiency, hippocampal blood supply deficiency can cause memory acquisition and memory consolidation obstacles, so that learning efficiency decreases. Insufficient blood supply to the occipital lobe can cause blurred vision and visual fatigue. The body’s regulatory mechanisms come into play to compensate for the supply of the posterior circulation, so that the entire brain
4, sympathetic nerves are provoked, there will be panic, palpitations, sweating, gastrointestinal dysfunction, and even heart pain.
5, affect the change of lumbar curve, symptoms of lumbar spine lesions. Such as lumbago, dysmenorrhea in women, abnormal sexual function in men and other disorders.
6, the combination of the above factors, coupled with the students’ own physical and mental development is still immature, can lead to emotional instability, insomnia and dreaminess, irritability and a series of symptoms, and even the emergence of obvious psychological disorders.
Not well treated, due to changes in the curvature of the neck, resulting in passive adaptation of the thoracic and lumbar vertebrae, the direct performance of young people is a bow back head leaning forward posture, the posture will change very early, the aging of the entire spine will come early.
Youth cervical spondylosis has attracted the attention of neurologists, orthopedists and massage specialists nationwide, and it has a great impact on the growth of young people and on the quality of our population. This problem should draw the attention of parents, schools and society, and should even cause a rethink of the current system of teaching to the test. Long-term high mental stress and a lifestyle with compulsion will have a very negative impact on the physical and mental health of adolescents, and even cause irreparable damage to the lifelong health and the development of emotional intelligence of children.
The treatment for cervical vertigo in adolescents is mainly a combination of massage, physical therapy and medication. Fortunately, adolescents are malleable, and the treatment effect and prognosis are relatively good, and with lifestyle adjustments, cervical spondylosis can be cured.