Dizziness is a common clinical disease, and the descriptions of dizziness, lightheadedness, dullness, confusion, dullness, confusion, dizziness, dizziness, and vertigo (which are different from dizziness) may be mentioned by the public when they see a doctor, except for vertigo (which is equal to dizziness with a sense of rotation of oneself or the surrounding environment, often feeling spinning and not daring to open one’s eyes), which has a special meaning, but the other descriptions do not differ much in substance.
Because of the complexity and variety of causes of vertigo, it is often difficult to make a clinical diagnosis, and some people joke that when they encounter a patient with vertigo, the patient is dizzy and the doctor is dizzy.
Studies have shown that the main cause of dizziness is benign positional vertigo, which can be diagnosed by special examination techniques of doctors. At the same time, psychological factors are also common causes of vertigo. If a long period of dizziness (more than six months) is not found to have an organic cause and related risk factors, or if it is really difficult to be explained with conventional medical knowledge, it should be considered functional, i.e. it may be related to psychological factors.
In fact, many patients have functional dizziness, and most of the doctors in the hospital will not stop until the root of the problem is identified by laboratory tests or instruments. Therefore, it is not difficult to understand the following phenomenon: we often see many patients who have been to many hospitals, seen many doctors, had or repeatedly had many tests and examinations, but still cannot find a solution, and finally the examination may reveal a small infarction by CT or MRI, or ultrasound suggests insufficient blood supply or arteriosclerosis, so the patient is put on the “posterior circulation ischemia, insufficient blood supply to the vertebrobasilar artery (this diagnosis is now (this diagnosis has been abandoned)”.
There seems to be a tendency for doctors to rely more and more on various laboratory tests or advanced instrumentation, while intentionally or unintentionally neglecting the practice of their own basic medical skills: seeking medical history and physical examination, both to be focused and targeted. Just like prospecting, you need to have a good drill and know where to drill.
There are many conditions that cannot be detected by laboratory tests or advanced examinations (no matter what test results are normal), such as functional (i.e., psychological) somatic symptoms. It takes skillful questioning by the doctor to find out what is wrong.
It is generally accepted that if dizziness occurs in patients aged 60 years (earlier to 50 years for smoking and hypertension), cerebral insufficiency is probably the most common cause, while only a small percentage of those under 50 years of age have cerebral insufficiency (there should be risk factors such as smoking, heavy drinking, hypertension, diabetes, obesity, hyperlipidemia or hyperhomocysteine, and vascular malformations).
People over 40 years of age basically have cervical degeneration (cervical spine osteophytes, either mild or severe), and it so happens that most dizzy patients are prone to dizziness or aggravated dizziness when turning or flexing their head and neck from side to side. It is common in clinical practice that regardless of the cause of dizziness, regardless of age (some are in their 20s) and the presence of risk factors for cerebral insufficiency, and without careful inquiry into the patient’s mood and sleep (one should also ask whether there was anything obviously unhappy or anxious before the illness), when the patient says that he or she is dizzy, the doctor can easily either classify the dizziness as cerebral insufficiency or diagnose dizziness caused by cervical spondylosis ( Insufficient blood supply to the brain due to compression of blood vessels or distortion). There is a 50-70% chance that this diagnosis will be correct, while the remaining 20-25% may see a few more doctors and then the doctor will see that the dizziness is not due to cerebral insufficiency and will consider that it is related to psychological factors (if no reasonable explanation is given, the patient’s compliance with treatment will remain poor and the treatment effect will be affected), and the last 5-10% will never be clearly diagnosed, so the patient will go around and the cause will always be difficult to understand. Naturally, the treatment is not pertinent and effective.
There are some cases of cerebral insufficiency that require detailed examination to clarify the specific cause, such as upright blood pressure drop, cerebral white matter degeneration, encephalitis, vestibular neuronitis, vascular malformation, early multi-system atrophy, hypotension caused by not paying attention to long-term antihypertensive drugs, high cranial pressure, heart disease or blood disease, cervicogenic causes, etc.
Typical clinical cases.
Case 1: Male, 72 years old, hypertensive for 10 years, non-smoker, small amount of alcohol, intermittent dizziness for 5 years, getting up and walking is obvious, obvious when just lying down, then relieved some, lying and standing blood pressure 145/80 mmHg and 140/78 mmHg, red tongue, thin yellow coating, thin string pulse. Ultrasound of the carotid artery suggested plaque in some parts of the body. Infusion of fluids (vasodilatation and activation of blood stasis) was mostly effective when dizziness was present. Diagnosis: cerebral blood supply deficiency, arteriosclerosis and narrowing of blood vessel lumen are the main causes. He was given Chinese medicine to activate blood circulation and remove blood stasis and tonify the liver and kidney, and western medicine to dilate blood vessels (not too strong, such as Cipro), and was told to get up as slowly as possible. Note: The aging of people is firstly in the aging of arteries, i.e. atherosclerosis: thickening of arterial intima, plaque formation, decrease of vascular elasticity, etc. Smoking, drinking, high blood pressure, high blood sugar and high blood fat will accelerate the progress of atherosclerosis.
Example 2: Female, retired teacher, 62 years old, dizziness for half a year with insomnia, hypertension for 2 years, well controlled, light red tongue, thin yellow moss, thin string pulse. (The local carotid ultrasound suggested a small plaque, but I don’t know which doctor explained to her that if the plaque continued to grow, it would block the blood vessel. So he went around to seek medical help without success, so doctors usually have to carefully consider every word they say, especially for patients with heavy hearts.
Since then, the patient’s dizziness has become more pronounced, and almost every month, he has to go to the emergency room and have all the tests done, such as head CT, MRI and vascular ultrasound. When she came to our brain clinic, she did not volunteer to tell me about her tortuous medical history, but came in with the results of TCD and carotid ultrasound in her hand and said that her dizziness was very severe and that there was plaque in her blood vessels, asking if the plaque could be removed with medication or surgery, and she described her condition in great detail. dizziness). I asked her if she had any other tests. She asked to have her blood pressure measured, and then went outside the office to call the second escort in to show her other documents from the past, and found many small copies of her medical history in the pile of documents. The main treatment first was anxiety and insomnia (also for cerebral blood supply deficiency), and she was given prozac plus blood activators and tranquilizers, and western medicine for anti-anxiety.
After 3 days of follow-up, she slept much better and her anxiety was reduced by at least half. This time, I explained to her again, she was obviously able to listen at ease, and later returned home to take her medication at ease. Patients become so anxious after getting sick that they seek medical help everywhere.
Example 3: Male, 38 years old, complained of right upper limb numbness with dizziness for 1 month, previously treated by a doctor for cervical spondylosis and brachial plexus radiculitis, which was slightly better, but the dizziness increased when he turned his head. After I received the patient, I carefully inquired and examined him and found that he actually had numbness in the right upper and lower extremities, only the lower extremities were lighter, and the patient smelled very much of smoke. Later, the MRI of the head suggested that multiple lacunar infarcts were treated with infusion, and at the second follow-up (4 days later), the dizziness was partially reduced. I got a cervical spine film that said cervical spondylosis, and I sometimes turn my head to aggravate the dizziness, right?” . He was asked to lie on his back with his body immobile, and his dizziness did increase when he turned his neck only. He finally realized that the cervical spine has no substantial effect on dizziness (the actual clinical percentage of cerebral blood supply deficiency caused by cervical spine factors is very small). This is probably because the intra-auricular (peripheral) vestibular labyrinth is more sensitive to changes in head position at this time (which is often the case regardless of the type of dizziness: i.e., dizziness may worsen with head and neck turning or changing position. It is also important to consider benign positional vertigo.
Comment: The subsequent TCD and carotid ultrasound of this patient (38 years old) suggested small sclerotic plaques in both internal carotid arteries and about 50% stenosis of the right vertebral artery. Generally, a normal person who does not smoke or drink alcohol would not have such a phenomenon until at least 55-60 years of age. The diagnosis given was: lacunar cerebral infarction, cerebral blood supply deficiency, and cervical spondylosis. The relationship between the three is that the first 2 are caused by the early arrival of atherosclerosis and have little to do with cervical spondylosis (which is actually quite mild). He was given vasodilatation, antiplatelet and herbal treatment to activate blood circulation and remove blood stasis, and the dizziness was significantly relieved after 2 weeks. He quit smoking and the dizziness gradually disappeared.
Case 4: Female, 30, accountant, dizziness for more than 1 year, fluctuating, aggravated roughly once a month upon careful questioning, relieved somewhat with a few days of rest, almost all tests on cerebral insufficiency of blood supply were done. I asked her if she had a feeling of weakness because her face was waxy and slightly pale, and she said sometimes she did. It was too much, she had just had a period, and sometimes she had to use up 2-3 pads in 1 day. I asked her to go downstairs immediately to check her blood count, hemoglobin about 10g, currently dizziness on the heavy side, blood pressure 95/60mmHg. light red tongue, thin white moss, sunken thin pulse. Diagnosis: dizziness due to anemia (also belongs to insufficient blood supply to the brain). It is recommended to see a gynecologist at the same time to find ways to reduce the blood in the uterus. The Chinese herbal medicine is given to Bazhen Tang to benefit the qi and replenish the blood, while enhancing the usual nutrition (and then recommending a recipe for food therapy), paying attention to more rest, reducing work intensity and avoiding overwork. The dizziness almost disappeared after only about 3 months.
Case 5: Female, 75, dizziness for 2 years, no hypertension, diabetes mellitus for 5 years, cranial MRI suggests a small amount of gap cerebral infarction with mild cerebral white matter degeneration (also belongs to the ischemic category), carotid ultrasound naturally has sclerotic-like plaque (no obvious stenosis). Every time I see a doctor, the doctor treats me for cerebral insufficiency, which is true, because at this age, it is natural to consider this disease. The strange thing is that sometimes the infusion works and sometimes it doesn’t work at all, and even worsens the dizziness, and the family is confused.
The first question I asked after the consultation was: “Does changing your position have any effect on your dizziness? In other words, does it reduce dizziness when you lie down?” The family said. The family member said, “You reminded us that this is the case with the old lady. It is obvious when she stands and walks, but less when she sits or lies down. Immediately, she asked her assistant to measure her blood pressure at 140/80 mmHg (in the recumbent position), 115/70 mmHg (in the immediate standing position), and 120/75 mmHg (after holding the standing position for 20 seconds). The textbook says that the criteria for diagnosing postural hypotension is a 30 mmHg drop in systolic blood pressure (and this is measured after holding the standing position for about 1 minute). In fact, I have seen a few cases like that, where the dizziness was apparent almost as soon as the patient got up, and the patient’s complaints were often told directly to the receiving physician, and most of them could be detected by the physician.
If the systolic blood pressure drops less than 30 mmHg, the patient will still be dizzy (called “postural blood pressure drop”), but it is not as typical and the symptoms can be mild or severe, so the doctor needs to take this possibility into account and take the initiative to ask the patient (“Is the dizziness affected by the position? Or would it be better to lie down immediately when dizzy?”) In this case, it is necessary to ask the patient to measure the blood pressure in different positions (also in sitting and standing position). In such patients (especially those with normal or slightly low basal blood pressure), vasodilators or antihypertensive drugs should be used with great caution, and even if they have to be used, they should be milder and in smaller amounts, otherwise they are not only unhelpful, but sometimes aggravate the dizziness.
Comment: This patient’s dizziness is a manifestation of insufficient blood supply to the brain, the main cause of which is naturally cerebral arteriosclerosis, and the postural blood pressure drop aggravates his dizziness, so vasodilators should be used with caution instead, and blood pressure cannot be lowered too low with hypertension. The patient was advised to reduce the dosage of antihypertensive drugs appropriately and the dizziness gradually improved.
Other diseases that cause dizziness include: atypical seizures, high cranial pressure, dizziness caused by degenerative lesions of the cervical spine, cervical radiculopathy, scalp neuritis, various lesions of the brainstem, inner ear vagus lesions, neuronitis, short-term decline in vestibular function, hypoglycemic reaction, cardiogenic dizziness, liver and kidney failure, and ophthalmogenic dizziness, etc.
Chinese medicine has a profound understanding of dizziness, and our ancestors developed many classical prescriptions with unique curative effects for dizziness, such as tonifying Zhong Yi Qi Tang, Tian Ma and Hooked Vine Drink, Calming Liver and Quenching Wind Soup, Han Xia and Bai Zhu Tian Ma Tang, and so on.
In clinical practice, the cause of dizziness should be clearly identified first, and it is crucial to choose targeted treatment. In many cases, Chinese herbal acupuncture combined with Western medicine can often be used to achieve satisfactory results.