Vertigo is a motion hallucination in which the patient feels that surrounding objects or himself are rotating, lifting and tilting. Cervical vertigo refers to vertigo caused by insufficient blood supply to the vertebral artery due to cervical lesions and often has the following characteristics: dizziness or vertigo accompanied by neck pain; dizziness or vertigo mostly occurs after neck activities; positive cervical torsion test in some patients; abnormal neck imaging, such as cervical frame retroflexion, vertebral instability, and disc herniation; history of neck trauma; and other causes are ruled out. Usually related to cervical spondylosis, but not necessarily caused entirely by cervical spondylosis.
I. Etiology
The etiology is not clear, but it may be due to compression of vertebral artery by cervical spondylosis or spasm of vertebral artery caused by stimulation of sympathetic nerve in the neck. The main cervical spondylosis related to cervical vertigo are vertebral artery type and sympathetic type. Cervical vertigo caused by sympathetic cervical spondylosis is due to vasoconstriction of the vertebral basilar artery caused by sympathetic nerve excitation, resulting in clinical symptoms such as vertigo, nausea, vomiting, etc. In contrast, cervical vertigo caused by vertebral artery type cervical spondylosis is due to compression of the vertebral artery, which leads to insufficient blood supply.
Clinical manifestations
1. Cervical vertigo is episodic vertigo, sometimes accompanied by nausea, vomiting, tinnitus, deafness and nystagmus. It occurs when the head is tilted back excessively or turned in a certain direction, and when it stops being tilted back or twisted, the symptoms disappear or are significantly reduced, which is also called positional vertigo. Cervical vertigo mostly occurs in people over 40 years old, and there is no significant difference between men and women, and the blood pressure is basically normal. It develops suddenly, often in the morning or after lunch break when you get up or turn your head.
2. Headache is mostly posterior occipital pain or migraine, which can be vague pain, throbbing pain or discharging pain. Some people take painkillers for years or suspect that there are occupying lesions in the skull.
3.Sudden collapse.
4.Brainstem symptoms limb numbness, abnormal sensation, light deviation of the contralateral limb and contralateral cranial nerve symptoms may occur in severe cases. Difficulty in swallowing, choking back, loss of gag reflex, hoarseness, ocular muscle paralysis, diplopia, blurred vision, Horner’s sign, etc. may also appear.
Examination
1.X-ray shows degeneration of the cervical vertebral body, intervertebral disc, hook joint and calcification of the collateral ligament, and changes such as straightening of the physiological curvature of the cervical spine.
2.Brain ultrasound can see reduced blood flow in the vertebral basilar artery.
Diagnosis
1. The onset of vertigo is mostly over 40 years old.
2. The onset of vertigo is often related to the change of neck position. When the neck is tilted back and rotated, vertigo or nausea can be induced.
3.It can be accompanied by neurogenic symptoms.
4.Sudden onset of vertigo often occurs when getting up or turning head suddenly, often accompanied by horizontal nystagmus.
5.Cervical spine examination shows that the movement of the neck is restricted, the spine of the affected vertebra is distorted, and there is pressure pain beside the vertebra, and the distortion of the spine of cervical 2 is common because the vertebral artery enters the transverse foramen and rises vertically, and multiple bends of the vertebral artery occur in this section from the 2nd cervical vertebra to before entering the greater occipital foramen, and the obstruction of the blood flow of the vertebral artery also occurs here.
6, cerebral hemogram, occipital breast leads, insufficient blood supply to the vertebrobasilar artery, positive neck twist test.
7, cervical spine X-ray plain film, front and side film, left and right oblique and open position film show that the physiological curve of the cervical spine is straightened, reverted, angled or interrupted, osteophytes, the posterior nodes of the cervical spine are upward, and the distance of the dentate process from both sides of the block is unequal.
V. Treatment
1.Massage the soft tissue of the neck.
2.Cervical spine traction.
For the elderly, narrowing of the vertebral space and obvious osteophytes, cervical traction treatment can be done. 10 times for a course of treatment. According to the needs of the condition, traction can be continued at intervals of 3 to 5 days.
3.Physiotherapy.
Relieve muscle spasm and eliminate local sterile inflammation. Commonly used ultrashort wave, infrared light, etc.
4.Closure.
Available 0.5% procaine solution, prednisone cervical posterior joint capsule closure, once a week, 3 times for a course of treatment.
5, drugs.
In the acute stage, appropriate vasodilators, such as betahistine (pethidine) sodium chloride injection 500 ml plus triclopidine (Vibrulon) static point, 10 days a course of treatment, with vitamin drugs such as vitamin B1, B6, etc. oral.
6.Surgical treatment.
After various conservative treatment does not work, serious osteophytes, cervical spinal stenosis, etc. need to be treated surgically.