Clinical features of common diseases of dizziness/vertigo Kaiyun Zhu, Department of Neurology, Panyu District Hospital of Traditional Chinese Medicine, Guangzhou, China
Benign paroxysmal positional vertigo-otolithiasis
◆Onset of vertigo when the head position changes: when you get up from bed, lift your head, turn your head or sit on a ladder, the symptoms disappear when you keep a certain position, and the symptoms are not obvious when you walk upright.
The duration of each attack is characterized by seconds, mostly within 10s.
◆ Dizziness during seizure, dizziness or faintness when not seized; Li Gang, Department of Neurology, Shenzhen People’s Hospital
◆ Less accompanied by nausea and vomiting
The vertigo is easily fatigable and self-improving; it can be recurrent
◆ No hearing loss, tinnitus and feeling of instability
◆ No central syndrome; normal hearing examination and temperature test
Migrainous vertigo (vestibular migraine)
◆ Female:male=4-5:1, age 20~50 years
◆ May have aura (vertigo may be), visual symptoms
◆ Onset: recurrent episodes of spontaneous vertigo with nausea, sometimes vomiting, photophobia, and preference for quietness.
Duration: It lasts for 1 hour (tens of seconds to several hours) and usually gets better after rest or sleep (next day).
◆ No or significant headache.
◆ Or history of migraine; shift in migraine form with age.
◆ Psychogenic vertigo or dizziness
◆ “Vertigo” is prolonged, persistent and unchanging.
◆ Many accompanying symptoms [somatization symptoms],
◆ Affected by external and emotional changes,
The patient is willing to find the objective cause: cervical spondylosis or insufficient blood supply.
◆ Willing to exhaust the examination and drug treatment
◆ Mental status assessment should be performed.
TIA or VBI of the vertebral basilar artery, posterior circulation ischemia (PCI)
◆ Patients mostly have atherosclerotic etiology, triple high
◆ Onset is often rapid, with symptoms lasting <24h,< span=""> mostly within 1 hour, sometimes lasting several minutes or more than 10 minutes
◆ Symptoms include vertigo, unstable walking, slurred speech, difficulty in swallowing, and perioral numbness.
Vestibular neuronitis
◆ Prodromal symptoms – history of upper respiratory tract infection before the attack
◆ Sudden onset of vertigo with nausea and vomiting.
◆ Vertigo mostly decreases in 1~2 weeks and relieves in 3~4 weeks.
◆ There may be spontaneous nystagmus, mostly to the healthy side, and the affected side is partial.
◆ No deafness and tinnitus; no central syndrome
◆ Temperature test with mild or total paralysis on one side
Ménière’s disease (Ménière)
Etiology: fluid accumulation in the membranous vagus, periodic rupture of the inner and outer lymphatic membrane separating the inner and outer lymph, and potassium ion paralysis of the vestibular sensory fibers.
◆ Manifestation: “Four major manifestations”
◆ Recurrent episodes of vertigo, every hour.
◆ Hearing loss (becomes obvious with the number of episodes)
◆ Tinnitus
◆ Stuffy feeling in the ear
◆ Temperature test: hypocapnia of the semicircular canal
Brainstem or cerebellar infarction or hemorrhage
◆ Vertigo, diplopia, nystagmus; oculomotor disorders
◆ Dysarthria, swallowing disorder
◆ perioral numbness, facial numbness; crossed sensory disorder
◆ Dizziness and unsteadiness, ataxia, fall attack
◆ Weakness of lower limbs (extremities), numbness of limbs
◆ hearing loss, tinnitus.
◆ confusion in the mind
◆ occipital headache