I. Vertigo caused by ear inflammation
Most commonly seen in otitis media and mastoiditis involving the vagus, divided into four types.
1. Periventricular vagalitis: mild vertigo, nystagmus, mastoid pain, vomiting and weakness of the affected muscles, normal vestibular function;
2. Restricted peri-vagalitis: seen in chronic suppurative otitis media and mastoiditis, commonly caused by cholesteatoma eroding the anterior wall of the horizontal semicircular canal, resulting in paroxysmal vertigo, nausea, vomiting and nystagmus;
3. Diffuse plasmacytic labyrinthitis: Most commonly seen in acute suppurative otitis media and mastoiditis, where bacteria invade the labyrinth via the vestibular fossa and can cause neurological deafness;
4.Diffuse chronic purulent otitis media: mostly seen in hemolytic streptococcal and pneumococcal infections.
Second, vertigo caused by drug poisoning
Such as SM, kanamycin, neomycin, quinine, dalantin, sodium salicylate, etc. SM sulfate damages the vagus vertigo more, and dihydro SM damages the cochlea more, with big auditory influence and big individual difference, and a small amount can develop in sensitive people. It usually occurs after 3-5 weeks of continuous injection, or it may appear a few days after the injection is stopped. The damage caused by SM is often permanent. The vertigo, nausea, unsteady walking and staggering gait caused by SM, often without nystagmus, can gradually improve after discontinuation of Darentine.
III. Positional vertigo
The occurrence of vertigo is closely related to the position of the head, such as when the head is turned back and forth to the left and right, and both periventricular and central vestibular can cause positional vertigo. Peripheral vestibular lesions are mainly seen in ear lesions in the inner ear, or trauma, infection, or blockage of blood vessels, causing atrophy of the vestibular organs. Patients often experience vertigo, nausea and vomiting less after a latency period of several seconds at the lowest point, and nystagmus, vertigo and nystagmus last only a short time, about several seconds, and the degree of nystagmus and vertigo diminish when the evoked position is repeated, which some people call “fatigue phenomenon”.
Central vestibular lesions are seen in posterior cranial recess lesions, such as tumors, arachnoiditis affecting CSF circulation or vertebral A with insufficient blood supply when the head position changes. Clinically, changes in head position in many directions can cause vertigo and nystagmus, but the symptoms appear rapidly, without a latency period and without fatigue phenomenon on repeated tests.
The differential diagnosis of these two types of vertigo can be identified by doing a positional nystagmus evocation test in addition to the previous one, by.
The patient sits on the bed with the head inclined to the affected side, so that he/she pays attention to the forehead of the examiner. The examiner holds the patient’s head with both hands and quickly pushes the patient into a supine position with the head inclined to the bed at 45 degrees, so that the head is turned 45 degrees to the opposite side, and nystagmus appears rapidly with a certain latency period, and the duration of the nystagmus is 5-10 minutes, and it appears only when the head is in this position, and the reflection is weakened when this test is repeated again, which is a peripheral vestibular lesion The nystagmus can occur in any direction.
Peripheral vestibular lesions are common, accounting for 18% of vertigo, are greater in women than in men, and are more common in women between 50 and 60 years of age. 80% of positional nystagmus when the eyes are opened for a subspecies examination is peripheral vestibular. It has been suggested that this test be done in all those who suspect the disease, also called benign paroxysmal positional vertigo due to its good prognosis, and positional nystagmus evoked test (+), which is its only positive sign.
There are three characteristics.
1, peripheral.
2. positional.
3. easy fatigability of nystagmus, with short duration of symptoms easily relieved.
IV. Meniere’s disease
Typical manifestations: episodes of vertigo, nausea and vomiting, tinnitus, deafness, and nystagmus. Etiology: autopsy reveals membrane vagus edema, fluid accumulation, endolymphatic fluid overproduction or absorption dysfunction.
1.Disorder of peripheral blood circulation theory: caused by vasospasm.
2, metabolic disorders theory: metabolic disorders, tissue edema, excessive salt intake, tissue edema caused by sodium retention; hypothyroidism can cause the disease.
3, foci and viral infection theory: tonsillitis can induce the disease, there have been advocated the removal of tonsils can treat the disease. Other foci such as appendicitis, cholecystitis, gallstones, mumps, upper sensory. The occurrence of vertigo sudden deafness is thought to be caused by a virus;
4.Phytodysfunction: mainly sympathetic nerve hyperfunction, which makes the blood circulation impaired.
5, vagus stroke: sudden vertigo, deafness Clinical young adults are common, 20-40 years old, older people are rare, children and over 70 years old are rare.
①Vertigo.
(ii) Nystagmus, which is not obvious or even disappears with prolonged illness, or no nystagmus.
③Cochlear symptoms: tinnitus, deafness, sometimes can exist for months, many patients have tinnitus and deafness before vertigo; 4) symptoms of phytodysfunction: nausea and vomiting are due to pathological excitation of the vestibular organs to the vestibular nucleus of the brainstem, which extends to the dorsal nucleus of the vagus nerve, there can be pallor, cold sweat, abdominal discomfort, diarrhea; differentiation of Meniere’s disease and Meniere’s syndrome: common The main symptoms of Meniere’s disease are the four main symptoms: the latter has a clear etiology and is often secondary to vestibular inflammation, trauma, hemorrhage, vestibular neuritis, meningitis, cerebellopontocerebellar tumors, etc.
V. Vertigo after head trauma
It is really pseudo vertigo, this dizziness and dizziness is common, typical vertigo is rare, common post-traumatic headache; if the trauma is accompanied by temporal bone fracture, 10%-15% have vertigo, there may be bleeding in the middle ear drum, deafness and tinnitus, vertigo, nystagmus is vertigo epilepsy.
VI. Vestibular neuronitis
It is generally thought to be caused by a viral infection and is common in adults, 20-60 years old, and occasionally in children. The onset of vestibular neuronitis is sudden, often after waking up, with severe vertigo, nausea and vomiting, not daring to open and close the eyes, and the symptoms are aggravated by lying in bed.
Differences from Meniere’s disease.
1. no cochlear symptoms.
2. vertigo symptoms last long and rarely recur after recovery, while Meniere’s disease has more recurrences.
3.More pre-symptoms of viral infection.
VII. Epidemic vertigo
Viral infection, fever, headache, general weakness, vertigo, nystagmus, but no cochlear symptoms, signs of brainstem damage, such as diplopia, facial palsy, oculomotor palsy, etc., can be recovered in 1-2 weeks; (viii) multiple sclerosis Multiple sclerosis with vertigo as the first symptom accounts for 5-12%, persistent vertigo and nystagmus are due to demyelination The vestibular nucleus is damaged, and cochlear symptoms are rare, often accompanied by vision loss, diplopia, vertebral fasciculus, and psychiatric symptoms, which can relieve relapse many times.
Cervical vertigo
It is a kind of vertigo caused by different disorders in the neck, such as vertebral artery compression syndrome, vertebral artery blood supply deficiency, cervical spondylosis syndrome, traumatic cervical headache.
Causes
1. The compression of vertebral artery in the course of cervical transverse foramen is mostly caused by cervical hypertrophic spondylitis and compression of vertebral artery by bone spur, especially when the neck is rotated or over-extended, and it is common that C5/6 C4/5 is the most active part of cervical spine. Some patients do not have bone spurs in the cervical spine, but the vertebral artery can still be narrowed when the cervical spine is rotated. In some other patients, the vertebral artery deformity is mostly at the beginning of the vertebral artery, and it and the subclavian artery are located between the anterior oblique muscle and the cervical fascia, so that the vertebral artery subclavian artery is often compressed when the neck is active, and this may be touched when the radial artery on one side is weakened by rotation or disappears.
2, cervical sympathetic nerve stimulation caused by spasm of the vertebral artery ;
3, other factors: neck trauma, soft tissue inflammation, with episodes of vertigo and headache; it may be caused by stimulation of the sympathetic nerve in the neck causing abnormal vascular function or reactive edema after injury to the muscle ligaments of the neck, which is transmitted to the cerebellum and vestibular nucleus via the posterior roots of the neck 1, 2, and 3 causing vertigo.
Clinical manifestations
1. vertigo, swaying, feeling of unstable standing fluctuation and rotation, some with tinnitus and nystagmus.
2, headache, 60-80% occurrence rate, confined to the superior occipital region or parieto-occipital region with visual hallucinations, nausea and vomiting.
3. disorders of consciousness, which occur suddenly when the head is turned.
4. Loss of vision, diplopia, hallucinations, and black haze.
IX. Brain lesions causing vertigo (vertigo epilepsy)
It is located in the posterior part of superior temporal gyrus or temporoparietal junction, where tumor, vascular malformation and small cerebral infarction can cause, hallucinations, transient vertigo or combined syncopal automatism;
X. Cerebellar pontocerebellar horn tumor
Auditory nerve tumor is common, accounting for 76.8% of cerebellar pontocerebellar horn tumor according to domestic statistics. Auditory nerve tumor often occurs on the sheath of vestibular nerve, often combined with 5, 6, 7 cranial nerve damage, mostly seen in middle-aged people. Early manifestations of auditory nerve tumor: tinnitus and deafness, vertigo, followed by trigeminal abduction damage.
Fourth ventricle and cerebellar earthworm tumor
Both can cause severe vertigo, nausea and vomiting/headache, visual disturbance, diplopia, arteriovenous papillary edema, arteriovenous hemorrhage.
In cerebellar earth tumors, mild vertigo, unstable standing, drunken gait, often without nystagmus, and vertigo in cerebellar hemispheres often with nystagmus; tumors in the fourth ventricle have certain mobility, especially tumors or cysts with tips, which suddenly block the fourth ventricle when the position or head position is changed, and acute obstructive hydrocephalus occurs, causing severe headache, vomiting and vertigo, and even impaired consciousness, called Brun’s sign. It is often misdiagnosed as positional vertigo due to change of head position, so we should be more alert.
Insufficient blood supply to the vertebral basilar artery mostly occurs in middle-aged or older patients with a history of arteriosclerosis or cervical spine disease;
1. vertigo, rotation, limb weakness, unsteadiness, tinnitus, hearing loss; 2. visual impairment, black midges, visual field defects
3. ataxia, Romberg (+), cerebellar vestibular damage.
4. headache, more than 30-50% with headache attacks, located in the posterior occipital and parieto-occipital regions, in the form of throbbing pain, eye pain, nausea and vomiting, cold sweats, vegetative dysfunction.
5. Impaired consciousness and brainstem ischemia. Involvement of the reticular system with syncope, fainting and weakness of the limbs.
6. localization signs of brainstem, bulbar palsy, crossed paralysis, tetraplegia.
XIII. Special ischemic syndromes of the vertebrobasilar system
1. subclavian artery steal syndrome.
2.Dorsolateral medulla oblongata syndrome (Wallemberg’s sign).
3. Spasm of the internal auditory artery: sudden hearing loss, vertigo (xv) Phytodysfunction as pseudovertigo, dizziness, nausea and vomiting, palpitations and sweating, insomnia, bilateral tinnitus, no deafness.