1. 70% of vertigo can be diagnosed after consultation Auntie Zhang asked: She often feels dizzy and light-headed. After reading the last lecture by Dr. Dong, I understand that this is vertigo and I should go to the hospital for treatment. What kind of case information should I bring with me when I go for vertigo treatment? How can I let the doctor understand the pain of vertigo and help him/her make a correct diagnosis? Dong Wanli A: Many people are always willing to emphasize the results of some previous tests and some irregularities of the doctors as the key points of their treatment, but in fact, they are not important and sometimes mislead the doctors’ thinking about the treatment. This is because no examination has any definite value for the diagnosis of vertigo, and the correct auxiliary examinations can at most help to exclude some diseases, but if they are used improperly, such as the increased blood flow found by TCD examination and the degenerative changes on cervical spine films, which are very common, they are often misunderstood by doctors and/or family members as the cause or diagnosis of vertigo, and the vertigo is misdiagnosed on the basis of insufficient blood supply to the basilar artery and cervical spondylosis. If the diagnosis and treatment of vertigo were correct, there would be no need to see the doctor again, but to see the doctor again is to hope for better results. In fact, the most important thing to diagnose the disease is a faithful and complete description of the onset of the disease, that is, the time of onset, the first symptoms, the main symptoms, the duration, the concomitant symptoms and the mode of relief, etc., and 70% to 80% of vertigo can be diagnosed or clearly directed by effective examination (without any auxiliary tests). In fact, for most of the diseases, the main focus should be to provide an accurate history, that is to say, first tell the doctor what happened to you since when? What pain are you currently experiencing? What do you want the doctor to fix for you? In this way, the doctor will be able to answer you what is going on (that is, to determine the medical diagnosis) and what to do about it (that is, to treat it). 2.What drugs can trigger vertigo? Ms. Liu asks: I often take a lot of medications for health reasons. I heard from a friend that some drugs can damage vestibular end receptors or vestibular pathways and cause vertigo? Is it true that drugs can cause vertigo? What should I pay attention to when taking medication? Dong Wanli A: Clinical studies have found that these drugs can damage vestibular end receptors or vestibular pathways and cause vertigo. Carbamazepine can cause reversible cerebellar damage, long-term application of phenytoin sodium can cause cerebellar degeneration, long-term exposure to heavy metals such as mercury, lead and arsenic can damage the cochlea, vestibular apparatus and cerebellum, and organic solvents such as formaldehyde, xylene, styrene and trichloromethane can damage the cerebellum. The postural instability and ataxia seen in acute alcoholism are the result of reversible damage to the semicircular canals and cerebellum. Common ototoxic drugs include: antibiotics such as aminoglycosides, vancomycin, viomycin and sulfonamides, antineoplastic drugs such as cisplatin, nitrogen mustard and vincristine, quinine, high-dose salicylates, diuretics such as tachykinuria and diuretic acid, and some local anesthetics applied in the middle ear, such as lidocaine. Dimethylaminetetracycline damages only the vestibule, and the vestibular toxicity of gentamicin and streptomycin is much greater than their cochlear toxicity. Nystagmographic tracings (ENG) and rotation tests sometimes reveal bilateral vestibular decline; hearing examinations reveal sensorineural deafness. Diagnostic recommendations: (1) History, signs and relevant ancillary tests and exclusion of other etiologies. (2) Vestibular function tests and/or hearing tests may be abnormal or normal. Treatment recommendations: discontinue medication, remove from the environment; bilateral vestibular function impairment, vestibular rehabilitation training is feasible. 3. Anemia can cause pseudovertigo. Auntie Li asked: One of her relatives often experiences dizziness and lightheadedness due to psychoneurological disorders. What is the difference between this kind of dizziness and other vertigo? Dong Wanli A: Many people experience dizziness and blackness in their daily life and think it is a vertigo attack. Dizziness, lightheadedness, fatigue, mental depression and lack of energy caused by anemia, coronary heart disease, psychoneurosis, etc., without the illusion of motion of spinning, floating, tumbling or drifting, are not strictly speaking true vertigo or pseudo vertigo. From this, it can be seen that the dizziness and lightheadedness caused by mental disorders and other systemic disorders are not real vertigo, but can also be called pseudovertigo. The main manifestations are dizziness, a sense of instability, and sometimes even a sense of fear of balance disorder. Patients usually have a sense of mental unclearness; anxiety symptoms such as difficulty in falling asleep and irritability, depression symptoms such as easy to wake up early, easy to get tired, and decreased interest, and somatization symptoms such as palpitations, nausea, and pain, which may be accompanied by excessive sweating and chilliness. If the examination is comprehensive, the diagnosis can generally be confirmed; when organic lesions need to be excluded, appropriate targeted ancillary tests are necessary. There is some debate as to whether there is a co-morbidity between dizziness in patients with anxiety and depression and mental disorders in patients with dizziness and vertigo. Treatment is mainly anti-anxiety, depression and psychological interventions. Dizziness associated with other systemic diseases also manifests itself mainly as a sense of instability and can be triggered when lesions damage the vestibular system. It is seen in: blood disorders (leukemia, anemia, etc.), endocrine disorders (including hypoglycemia, hypo- or hyperthyroidism, etc.), reduced ejection in cardiac disorders, hypotensive, disorders of body fluid ions and acidity from various causes, eye disorders (ocular muscle paralysis, ocular clonus, significant inconsistency in binocular vision, etc.). 4.What are the treatments for common vertigo Auntie Zhang asks: Sometimes when I stand up after sitting for a long time, I feel dizzy and black in front of my eyes. Some people say this is a vertigo attack, while others say it is Meniere’s disease, insufficient blood supply to the vertebrobasilar artery or cervical spondylosis. Is this kind of dizziness considered vertigo? What are the treatments for common vertigo? Dong Wanli A: Vertigo is a common condition, but it is not well understood clinically at home and abroad, and is easily misdiagnosed and mistreated. True vertigo emphasizes the false sensory state of spinning around or rolling upside down by oneself, that is, mistakenly thinking that the surroundings are moving or oneself is moving. There is a wide variety of causes of vertigo. The common treatments for vertigo are etiological treatment and symptomatic treatment. Etiological treatment: If the cause of vertigo is clear, we should take timely and targeted treatment measures, such as otoliths (benign positional vertigo, BPPV), which should be treated by different manipulative repositioning (CRP) depending on the affected semicircular canal, and often receive dramatic results (hand to hand!) In acute basilar artery ischemic strokes, immediate thrombolytic therapy is indicated in appropriate patients with 3-6 h of onset. Symptomatic treatment: For vertigo attacks lasting for several hours or frequent attacks, where the patient has a severe autonomic response and needs bed rest as a result, vestibular depressants are generally needed to control the symptoms. At present, vestibular depressants are mainly divided into antihistamines (iproniazid, diphenhydramine, etc.), anticholinergics (scopolamine, etc.) and benzodiazepines; antiemetics include gastroflucan and chlorpromazine, etc. Vestibular inhibitors work mainly by inhibiting neurotransmitters, but if applied for too long, they can inhibit the establishment of central compensatory mechanisms, so it is advisable to discontinue them when the patient’s acute symptoms are controlled; inhibitors are not suitable for patients with permanent impairment of vestibular function, and dizziness is generally not treated with vestibular inhibitors. Psychotherapy can eliminate the fear psychology and anxiety and depression symptoms caused by vertigo, and antidepressant and anxiolytic drugs such as Dextran should be used when needed. Betahistine is a strong antagonist of histamine H3 receptors, and some European studies have confirmed its effectiveness in treating Meniere’s disease. The use of calcium antagonist thorns, Chinese herbal medicines, nicergoline, ginkgo preparations, and even carbamazepine and gabapentin for vertigo has been reported; baclofen, epinephrine and amphetamine have also been reported to accelerate vestibular compensation. Of course, the specific treatment medication should be applied under the guidance of a specialist. 5.What to pay attention to after the vertigo is cured Mr. Cai asked: He is 68 years old and his vertigo has been cured by the wonderful hands of Professor Dong. Now he wants to know what else he needs to pay attention to in his daily life after his vertigo is cured. What should I not eat? What should I not do? Will vertigo come back again? Dong Wanli A: Most of the vertigo is curable, since it is cured, it is back to normal (no more vertigo), so you should have a normal life and diet and not live a fearful life because of the fear of recurrence. There is no need for patients to listen to folk advice and be afraid to do this or eat that. They should cherish the success of the cure and live a normal life with quality of life. It is undeniable that vertigo can recur, and recurrence or reoccurrence after cure is roughly estimated to be about 30%, which is determined by a variety of factors and may be inevitable, and there is no such thing as not having it just by being scared, not daring to move around and avoiding food. Therefore the scientific approach is to live a normal life, no hair is better, hair and then cure, the treatment is still very good.