Cervical vertigo in the elderly is a series of clinical symptoms and signs such as vertigo, nausea and vomiting, which are caused by insufficient blood supply to the vertebrobasilar artery due to stimulation or compression of the vertebral artery, and is one of the common diseases in the elderly.
I. Etiology
Insufficient blood supply to the vertebrobasilar artery occurs in the elderly because of the following physiopathological characteristics of the elderly.
1. Bone proliferation
Bone spurs can stimulate or compress the vertebral artery, resulting in reduced blood flow.
2, vascular lesions
Atherosclerosis is common in the elderly, which can easily lead to insufficient blood supply to the vertebral artery.
3.Cervical intervertebral disc degeneration
Narrowing of the vertebral space, relative shortening of the cervical spine, relative lengthening of the vertebral artery, folding or distortion, affecting the blood circulation of the vertebral artery.
4.Cervical spine misalignment
When the cervical disc degenerates, the vertebral space narrows, the joint capsule and intervertebral ligaments relax, and the cervical spine becomes unstable. Under the action of external force, the cervical spine is easily misaligned, stimulating the sympathetic plexus around the vertebral artery or directly compressing the vertebral artery, causing spasm or narrowing of the lumen of the vertebral artery and reducing blood flow.
II. Clinical manifestations
1.Cervical vertigo
It 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, with no significant difference between men and women, and with basically normal blood pressure. The onset of vertigo is sudden, often due to getting up in the morning or after lunch break or turning the head.
2.Headache
It 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
Numbness of limbs, abnormal sensation, light deviation of contralateral limbs 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.
III. Examination
Hemoglobin, blood glucose, lipids, urea nitrogen, etc. should be checked.
1.X-ray cervical spine
The cervical vertebrae, intervertebral discs, hook joint degeneration and calcification of the collateral ligament, and changes in the physiological curvature of the cervical vertebrae such as straightening can be seen.
2.Brain ultrasound
It can be seen that the blood flow of vertebral basilar artery is reduced.
Diagnosis
Diagnosis can be confirmed based on clinical manifestations, cervical spine examination, cerebral hemogram, and cervical spine X-ray plain film.
V. Treatment
1.Cervical spine rotation and reset method
Adopt Feng Tian You cervical spine rotation reset method to correct the distorted spinous process, so that the affected vertebrae can restore the original anatomical position and release the stimulation or compression of vertebral artery, and the clinical symptoms and signs can be reduced or disappeared.
2.Massage the soft tissue of the neck
3.Cervical spine traction
For elderly people, patients with narrowed vertebral space and obvious osteophytes can do cervical traction treatment.
4.Physiotherapy
Relieve muscle spasm, eliminate local sterile inflammation, commonly used ultra-short wave, infrared light, etc.
5.Closure
0.5% procaine solution 8ml, prednisone 0.5ml cervical posterior joint capsule closure, once a week, 3 times for a course of treatment.
6.Drugs
(1) Betahistine (pethidine hydrochloride) orally.
(2) Infusion of 5% glucose solution 500ml plus Chuanxiongzin 160mg sedation.
7.Surgical treatment
Those who have been ineffective by various conservative treatments, serious osteophytes, cervical spinal stenosis, etc. need surgical treatment.
VI. Prognosis
The prognosis is generally good, mainly to prevent accidental fall.