Vertigo is a kinetic or positional illusion due to the body’s impaired spatial orientation. Vertigo usually reflects a lesion in the vestibular area, and it is a symptom, not a name for a disease. Vertigo can be divided into true vertigo and pseudovertigo. True vertigo is caused by diseases of the eye, proprioception or vestibular system with a distinct sensation of external objects or self rotation. Pseudovertigo is mostly caused by systemic systemic diseases, such as cardiovascular disease, cerebrovascular disease, anemia, uremia, drug intoxication, endocrine disease and neurosis, etc. Almost all of them have symptoms of dizziness of varying severity without a clear sense of rotation.
I. Classification
1.Peripheral vertigo
Vertigo caused by lesions in the vagus or vestibular part of the inner ear or extracranial segment of the vestibular nerve (within the internal auditory canal) is peripheral vertigo, including acute vaginitis, Meniere’s disease, etc. Its characteristics are.
(i) vertigo is intense rotational, short duration, and the change of head position or body position can aggravate vertigo significantly.
(2) Nystagmus: nystagmus coexists with vertigo attack, mostly horizontal or horizontal plus rotational nystagmus. Usually there is no vertical nystagmus, the amplitude can be changed, and the nystagmus may subside or disappear after a few hours or days. Head position induced nystagmus is mostly fatigue, and temperature induced nystagmus is mostly seen in hemianopia.
(iii) Balance disorders: mostly rotational or up-and-down swaying motion sensation, unstable standing, spontaneous tilting, static upright test mostly tilting in the direction of the slow phase of nystagmus.
④Autonomic symptoms: such as nausea, vomiting, sweating and pallor, etc. ⑤ Often accompanied by tinnitus and hearing impairment without brain function damage.
2.Central vertigo
It refers to vertigo caused by lesions in the vestibular nucleus, brainstem, cerebellum and temporal lobe of the brain. Features.
(1) The degree of vertigo is relatively light, long-lasting, rotational or motion sensation to one side, which can be reduced after closing the eyes and is not related to head or body position change.
(2) The nystagmus is coarse and can be a single vertical nystagmus and/or a horizontal, rotational type, and can persist for a long time with constant intensity. The direction of nystagmus is not consistent with the side of the lesion, and the direction of spontaneous tilting and static upright test tilting are not consistent.
(iii) Balance disorder: It is manifested as rotational or to one side motion sensation and unstable standing. Most of the vertigo and balance disorder are inconsistent in degree.
④Autonomic symptoms are not as obvious as peripheral ones.
⑤No hemianopia, hearing impairment, etc.
⑥It may be accompanied by brain function damage, such as cerebral nerve damage, extraocular muscle paralysis, facial and tongue palsy, ball palsy, limb paralysis, high cranial pressure, etc.
II. Common vertigo disorders
1.Otoliths
It is the most common in clinical practice and is mostly seen in otorhinolaryngology. It starts suddenly with persistent vertigo, which is relieved after a few days and turns into episodic vertigo. However, vertigo occurs when the head is in a certain position and can last for tens of seconds, and it can be reduced or disappeared when the head is turned or reversed. Significant nystagmus can be seen, and the duration of its vertigo varies greatly, and most of it resolves itself or disappears within a few hours or days after the onset.
2. Meniere’s disease
The clinical manifestation of Meniere’s disease is intermittent recurrent attacks of vertigo, with intervals ranging from days, months to years. The vertigo is often sudden, starts with the most severe degree, intensifies with head movement and eye opening, and is mostly accompanied by tilting, panic due to the feeling of violent rotation and movement, accompanied by tinnitus, deafness, nausea, vomiting, pallor, slow pulse, drop in blood pressure and nystagmus. The duration of each attack varies from a few minutes to a few hours, with some attacks lasting for several days. After each episode, fatigue and sleepiness are present. Balance and hearing return to normal during the interval. After several attacks, the vertigo decreases as the deafness on the affected side increases, and disappears when the deafness progresses to complete deafness.
3. Ischemic lesions of the VBA system of the vertebral basilar artery
There is nystagmus without other signs and symptoms of the nervous system. It is classified according to clinical manifestations as
(1) Transient ischemic attacks are indefinite and may occur several times a day or once in several days, and usually resolve or disappear in a few minutes to half an hour. In mild cases, there is only vertigo and instability, but in severe cases, frequent attacks progress to complete vagal stroke.
(2) Progressive stroke with vertigo, tinnitus, and deafness continue to progress and worsen after the onset of stroke, reaching a peak after a few days.
(3) Vertigo, instability, tinnitus, and deafness peak a few hours after the onset of complete stroke, with significant nystagmus. Symptoms may gradually decrease after a few weeks. Dizziness is often associated with hearing impairment.
There are other lesions that can also cause vertigo, all of which fall under the category of vertigo, such as cerebellar hemorrhage, neck lesions, intracranial tumors, craniocerebral trauma, drug or toxic poisoning, inflammatory demyelinating diseases, etc.