Introduction.
Topping the hot sun head out, these days is indeed the need for courage. High temperatures, even with sunglasses, hats, umbrella equipment, the street for 10 minutes will still be drenched in sweat, dizzy. When you walk into the outpatient rooms of major hospitals, there are many patients, many of whom are young people, who tell doctors that they are “dizzy”, “vertigo” and “unsteady”.
The headache and vertigo of heatstroke are often cured after the relief of heatstroke, while some people have dizziness symptoms that linger for a long time and cannot be cured by repeated visits to the doctor.
Auntie Shen, who is over 60 years old this year, has recently tasted the pain of vertigo. Waking up early that morning, Auntie Shen felt the sky spinning around her when her head moved, and she was afraid to open her eyes, and severe nausea, frequent vomiting, so she was bedridden, and she lost weight in a few days. When she went to the hospital, she was told that it was “cervical spondylosis or vertebral basilar artery blood supply deficiency (VBI)”, and she had blood tests, X-rays (some even MRI films) and hangings, but it was not good; she was diagnosed with “Meniere’s disease”, and she was given medicine, but several thousand dollars were spent, but there was no effect at all.
1.There are many reasons for vertigo
When vertigo strikes, there are often symptoms such as nausea, vomiting, sweating, weakness, nystagmus, unsteadiness or fear of activity.
In life, there are often patients who have sudden attacks of vertigo. At this time, you should look for fixed objects around you, hold on to them firmly, lower your own center of gravity as much as possible, squat, or sit down on the ground to avoid falling due to imbalance, which may cause fracture or cranial trauma; rest flat on your back if possible, avoid head movement, turn your head to one side so that vomit can be discharged smoothly and prevent vomit from flowing back into the respiratory tract to cause asphyxia or aspiration pneumonia, and draw the curtains to make the room softer. Close the curtains, make the room softly lit, and keep the room quiet; accompany the patient with family members and give comfort to the patient, don’t be nervous, and eliminate the patient’s anxiety and fear; take sedatives when panic attack is appropriate. After the symptoms of vertigo improve a little, send the patient to a specialized hospital for further examination and treatment.
In fact, there are many different causes of vertigo, but clinically they are classified into two categories: peripheral vertigo and central vertigo, which are simple to distinguish and valuable for treatment.
The vertigo caused by damage to the inner ear and vestibular apparatus is peripheral vertigo, which accounts for 75% of vertigo. The common ones are benign episodic positional vertigo (BPPV), Meniere’s disease, vestibular neuritis, sudden deafness and vertigo caused by inner ear drug poisoning (e.g. streptomycin poisoning, phenytoin sodium poisoning, salicylates and quinine).
Vertigo caused by cerebellar and brainstem lesions has many causes, and cerebrovascular diseases, tumors and degeneration are more common, and their vertigo should be combined with the manifestation of nerve damage (symptoms, signs or experimental examination), but although there are many kinds of these neurological diseases only account for about 25% of vertigo, the common ones are: posterior circulation ischemia, auditory neuroma, migrainous vertigo and epileptic vertigo.
2.What are the common treatments for vertigo
During the diagnosis and treatment of vertigo, the first thing that should be clarified is whether the individual is dizzy, lightheaded or vertigo. Vertigo and dizziness are two different feelings that often suggest different disease types, and most clinical patients cannot tell the difference between the two.
Vertigo manifests as spinning in the sky and often suggests neurological pathology, with dozens of disease types, including Meniere’s syndrome. Dizziness, on the other hand, manifests as intracranial dizziness and discomfort, accompanied by forgetfulness, weakness and unsteadiness in walking, and is mostly caused by chronic diseases such as neurasthenia, hypertension and hypoglycemia.
The current common methods of treating vertigo are.
(1) General treatment. To maintain nutrition through intravenous infusion, to improve the oxygen supply to the inner ear through oxygen inhalation, to improve the patient’s mental condition through psychiatric treatment, to gradually get out of bed after the symptoms are relieved, and to avoid long-term bed rest;
(2) Drug therapy. Take sedatives and tranquilizers to eliminate anxiety, antihistamines to relieve nausea and vomiting, injections of vasodilators and calcium antagonists to improve the blood supply to the inner ear and relieve small artery spasm, etc;
(3) Resetting by manipulation (CRP). It is a special treatment for benign positional vertigo, which can clean the dislodged otoliths into the abdomen of the jug and absorb them to achieve a cure;
(4) Vestibular rehabilitation is helpful for all persistent vertigo to adapt to life.
(5) Surgery and other treatments. Including: sympathectomy, endolymphatic sac surgery, vestibular neurectomy, vagus disruption and gentamicin therapy.
(6) Chinese medicine treatment. According to TCM, vertigo is mostly caused by hyperactivity of liver and yang, deficiency of qi and blood, deficiency of kidney essence, and obstruction of phlegm, so the main treatment should be to pacify liver and subdue yang, benefit qi and nourish blood, tonify liver and kidney, and dry dampness and resolve phlegm. Commonly used methods include pillow therapy, moist heat compress, ear plug therapy, ear point therapy, foot bath therapy, etc.
3.Most vertigo can be removed by hand
Benign episodic positional vertigo (BPPV) is the most common vertigo disease, accounting for about half of all vertigo, and according to statistics, half of the elderly people over 70 years old in the United States have had BPPV at least once in their lifetime.
It is caused by the dislodgement of the otoliths (normally present) in the inner ear, and the attacks are position-related, transient and recurrent, mainly because the otoliths in the inner ear are dislodged and float in the semicircular canal, and when the position of the person changes, the “stones” float and produce vertigo.
The vertigo is induced by a certain change of head position, which is a distinctive feature of benign episodes of positional vertigo, such as a spinning attack when sitting up, lying down, turning over or fetching things with head down, washing hair, or tilting back to dry clothes.
Vertigo is a disease that can be easily misdiagnosed and mistreated: many clinicians cannot accurately grasp the symptoms of vertigo, and patients can easily confuse it with other symptoms (often with dizziness, lightheadedness, unsteadiness and syncope) when they complain of it, or even directly tell the physician that they have Meniere’s disease, cerebral blood supply deficiency or cervical spine disease (they often present cervical spine X-ray films at the same time), without telling the specific performance, so it is difficult to accept other diagnoses from the physician. This, together with the fact that most middle-aged and elderly patients do have cervical degeneration or increased blood flow in the TCD (but not necessarily the responsible lesion), leads to the classification of a large number of patients with dizziness or vertigo as having inadequate blood supply to the basilar artery, Meniere’s disease or cervical spondylosis, resulting in multiple adverse consequences for the patient.
In fact, most vertigo is curable: clinically, we have seen patients with vertigo who have suffered from episodes of vertigo for decades and are therefore pessimistic about the efficacy of vertigo, and even some physicians have told patients that vertigo can never be cured. According to the clinical reports, the incidence of BPPV is about 45% to 65%, and the cure rate is about 97% by various methods of otolithic repositioning. In addition, vestibular neuritis and other vertigo diseases can also be cured.
Manual repositioning is a method in which the doctor clears the “stone” into the abdomen of the jug during the treatment and absorbs it, so that the patient gets permanent improvement. Usually an experienced doctor can cure the disease with about 12-30 minutes of manipulation, and most of the patients can be cured with one session of manipulation. Patients can be treated without injections or medication by choosing manual repositioning, which often saves examination fees, medication fees and valuable time, and avoids hospitalization and surgery.
4. Correct understanding of Meniere’s disease, cervical vertigo and insufficient blood supply to the basilar artery
Meniere’s disease is an accumulation of water in the labyrinth of the inner ear. The typical manifestation of Meniere’s disease is that in addition to vertigo, there must be ear symptoms such as ear stuffiness, ear swelling, sound allergy, tinnitus, ear closure and fluctuating deafness. The onset of symptoms may be relieved by a few hours to a few days and may be accompanied by sensitivity to light. However, it varies greatly among individuals. The main treatment is to limit the intake of salt and water. Meniere’s disease accounts for about 5% to 9% of vertigo-like disorders.
Insufficient blood supply to the vertebral basilar artery is essentially an ischemic cerebrovascular disease, but cervical spondylosis is not its cause. Cervical spondylosis is also not a cause of vertigo. Therefore, in some cases, cervical spine X-rays showing osteophytes or degenerative changes or TCD showing increased blood flow are not only of no diagnostic value, but sometimes mislead the diagnosis due to misunderstanding.