Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?
Dizziness significantly complicates a person’s life. Many people are familiar with this unpleasant feeling of loss of balance and instability, when it seems that the ground is disappearing from under their feet. This often leads to falls and various injuries. In medicine, this symptom is called vertigo. In most cases, doctors diagnose patients with non-systemic dizziness. What it is? And how to get rid of this type of vertigo?
What it is
Dizziness of a non-systemic nature is caused by physiological or psycho-emotional reasons. It is otherwise called non-vestibular vertigo. In the human inner ear there is a special organ of balance - the vestibular apparatus. It is responsible for the stability of the body. If vertigo is non-systemic in nature, then it is in no way related to pathologies of the inner ear. The vestibular system remains normal. However, the person often experiences a feeling of dizziness.
Vertigo itself is not considered a disease. It can only be a symptom of various pathologies or a sign of the impact of various unfavorable factors on the body.
Difference from the systemic form of vertigo
What is the difference between non-systemic dizziness and systemic one? If vertigo is systemic in nature, then it is associated with various lesions of the vestibular analyzer. With non-systemic vertigo, diagnostics do not reveal pathologies of the balance organ.
Different types of dizziness differ in their manifestations. In the systemic form, a person complains of the following symptoms:
- There is a false sensation of rotation of surrounding objects.
- There is a feeling of circular motion own body.
Such manifestations are observed in Meniere's disease, labyrinthitis and other lesions of the inner ear.
Dizziness of a non-systemic nature is never accompanied by a sensation of rotation and movement. For this reason it is called false vertigo. However, an attack of this condition is quite difficult to bear. Patients complain of the following symptoms:
- Weakness and nausea occur, as before fainting.
- There is a feeling of instability and loss of balance.
- The patient experiences anxiety and a strong fear of falling.
- The person's eyes darken.
- Sometimes there is a feeling of a veil before the eyes and a feeling of intoxication.
In medical practice, non-systemic types of vertigo are diagnosed much more often than pathologies of the balance organ.
Types of non-vestibular vertigo
Symptoms and treatment of non-systemic dizziness depend on its form. There are several types of non-vestibular vertigo:
- Swoon. In this case, a state close to pre-fainting occurs; the person is afraid of losing consciousness. Lipotymia can be caused by the most different reasons, which we will consider next.
- Psychogenic form. Appears against the background of psycho-emotional experiences.
- Mixed form. In this case, vertigo is one of the symptoms of pathologies of the spine and central nervous system.
Causes
The causes of non-systemic dizziness will depend on the type of balance disorder.
The most common case of vertigo is lipothymia (presyncope). It can have both physiological and pathological causes. This condition can occur under the influence of the following factors:
- In this condition, a person experiences a loss of balance when changing body position. This is due to a temporary drop in blood pressure. This symptom is often observed in older people. Orthostatic collapse is also side effect many medications.
- Pregnancy. Dizziness usually appears in the first three months. It is associated with hormonal changes in the body.
- Diseases of cerebrovascular vessels. Diseases such as atherosclerosis are accompanied by cerebral circulation disorders. As a result, brain nutrition is sharply disrupted and imbalances occur.
- Anemia. With low levels of hemoglobin and red blood cells in the blood, the delivery of oxygen to the brain is also impaired.
- Diabetes mellitus. Due to improper administration of insulin, diabetics may experience hypoglycemia - a drop in glucose levels. This condition is accompanied by a serious deterioration in well-being and dizziness.
- Menopause. During menopause, a woman’s well-being often worsens due to hormonal changes. Some patients experience imbalance with a feeling of lightheadedness.
- Intoxication. Non-systemic dizziness in case of poisoning is a fairly common occurrence. It occurs due to intoxication with various chemicals, stale food and alcohol. In this case, vertigo is often accompanied by nausea and vomiting. Dizziness with infectious diseases. It is caused by poisoning of the body with bacterial and viral toxins.
Another common form of vertigo is associated with psycho-emotional factors. The following circumstances can trigger an attack of dizziness:
- anxiety states;
- stress;
- depression;
- neurocirculatory dystonia, accompanied by panic attacks.
In such cases, it is sometimes very difficult to identify the etiology of non-systemic dizziness. After all, the examination does not reveal any organic pathologies in the patient.
There is also vertigo with mixed symptoms. It is often observed in patients with osteochondrosis and other degenerative diseases of the spine. Dizziness is accompanied by a variety of painful manifestations. This type of vertigo is especially common in pathologies of the cervical spine.
Another cause of this type of dizziness is Arnold-Chiari syndrome - a congenital pathology of the cerebellum. This organ is responsible for coordination of movements and balance. Due to improper development of the skull bones, the cerebellum is compressed. As a result, the patient experiences persistent vertigo.
Presyncope
Lipotymia is often accompanied by a drop in blood pressure. In this case, the patient experiences the following symptoms of non-systemic dizziness:
- nausea;
- severe weakness;
- sweating;
- darkening of the eyes;
- lightheadedness;
- feeling of impending loss of consciousness;
- pale skin;
- noise in ears;
- deterioration of lateral vision;
- loss of balance.
If the attack is associated with orthostatic collapse, then the patient’s condition quickly normalizes. However, if dizziness is caused pathological reasons, then such conditions can be observed for a long time.
Vertigo of psychogenic nature
It is not uncommon for a patient to experience attacks of vertigo every day. Unsystematic dizziness can bother a person for many months and even years. In this case, a neurological examination does not reveal any neurological or vascular pathology in the patient. In these cases, the imbalance usually has a psychogenic etiology.
An attack of vertigo occurs like a panic attack. It is accompanied by the following manifestations:
- feeling of severe anxiety and fear;
- sweating;
- unpleasant sensations in the heart area;
- tachycardia;
- difficulty breathing;
- loss of stability;
- nausea;
- shortness of breath.
In patients with neurocirculatory dystonia, such attacks may not occur constantly, but only under certain circumstances, for example, during severe anxiety or fear. In people suffering from various phobias, psychogenic dizziness may appear when being at a height or in an open space.
Dizziness with mixed symptoms
With osteochondrosis, dizziness is usually combined with pain in the neck and head. The patient's gait becomes unsteady and unsteady. Typically, vertigo occurs only during movement and disappears at rest.
In Arnold-Chiari syndrome, vertigo is accompanied by pain in the back of the head, blurred vision, loss of coordination and ringing in the ears.
How dangerous is this?
Is non-systemic dizziness dangerous? In some cases, this symptom may signal a serious problem in the body. As already mentioned, vertigo can indicate problems with the spine, central nervous system and blood vessels. And such pathologies require immediate and timely treatment. Therefore, imbalances should never be ignored. Vertigo should be a serious reason to see a doctor.
If we consider dizziness as a separate phenomenon, it often leads to falls. There is always a risk of injury.
In addition, the feeling of instability negatively affects the patient’s mental state and quality of life. Many people with balance problems experience anxiety and are often afraid to leave the house for walks.
Diagnostics
How to identify non-systemic dizziness? First of all, it is necessary to separate this pathology from the vestibular form of vertigo. It is necessary to tell your neurologist in detail about your feelings during an attack of dizziness. It is important for a specialist to know whether vertigo is accompanied by a sensation of rotation of surrounding objects and one’s own body. It is this symptom that allows us to differentiate vestibular pathology from non-vestibular pathology.
However, the patient cannot always adequately assess his feelings during an attack. After all, at this moment he experiences a feeling of fear and anxiety. Therefore, in neurology there are special techniques that allow you to determine the nature of dizziness. The doctor may suggest the patient undergo the following tests:
- Finger-nose test. The patient is asked to close his eyes, stretch out his arms and touch the tip of his nose with his index finger. With vertigo, the patient loses balance during the test.
- Dix-Hallpike test. The patient sits on a chair with his back straight. The doctor turns the patient's head and then asks him to quickly lie down. If at the same time dizziness and scleral trembling appear, then this sign indicates vestibular disorders.
Additionally, an X-ray of the spine, Dopplerography of the cerebral and cervical vessels, MRI and CT of the brain, and an electroencephalogram are prescribed. This helps to identify neurological pathology.
Drug therapy
The choice of treatment for non-systemic dizziness depends on the etiology of this symptom. If vertigo is caused by pathologies of the brain, cerebral vessels or spine, then it is necessary to treat the underlying disease.
To stop attacks of dizziness, doctors also provide symptomatic treatment. The following groups of drugs are prescribed:
- Nootropic drugs: Piracetam, Cinnarizine, Phezam, Cavinton, Phenibut. These remedies improve cerebral blood circulation and brain nutrition.
- Sedatives and antidepressants: Seduxen, Phenazepam, Amitriptyline. Such drugs are useful for dizziness caused by anxiety and stress.
- Antihistamines: Pipolfen, Dramina, Diphenhydramine. They reduce nausea and have calming properties.
- Antiemetics: Ondansetron, Motilak. Relieves nausea and vomiting during an attack.
Vertigo of psychogenic origin usually responds well to symptomatic treatment. In other cases, it is possible to completely get rid of dizziness only after eliminating its cause.
A set of exercises
As already mentioned, this type of vertigo is not associated with pathologies of the balance organ. However, doctors recommend performing exercises to train the vestibular analyzer. This will help reduce the unpleasant symptoms of dizziness.
It is useful to regularly perform the following exercises:
- turns of the head and body;
- bends;
- revolutions around oneself;
- swinging on a swing;
- breathing exercises.
It is important to remember that you should consult your doctor before doing this. For elderly patients with vascular diseases, exercises can only be performed in a gentle mode. The intensity of classes should be increased gradually, listening to your well-being.
Folk remedies
Is it possible to get rid of dizziness attacks using home remedies? Rely completely on traditional medicine in this case it is impossible. However, home recipes can complement drug therapy:
- Tea with lemon balm. You need to take a tablespoon of chopped herbs and place it in a glass of boiling water. Then the drink is infused for 15-20 minutes. It helps improve blood circulation in the blood vessels of the brain and reduce headaches. When dizziness begins, you need to slowly drink a glass of this tea.
- Massage with oils. You need to take camphor (100 ml), fir (30 ml) and juniper oil (10 ml) and mix well. This mixture is applied to the scalp and rubbed.
- Drink made from honey and apple cider vinegar. Dissolve 2 teaspoons of apple cider vinegar and 1 teaspoon of honey in a glass of boiling water. This remedy should be drunk in the morning or before meals. It not only helps with dizziness, but also lowers cholesterol.
Such remedies are especially useful for the psychogenic form of vertigo. They help calm the nervous system and eliminate anxiety.
Prevention
How to prevent dizziness attacks? Neurologists advise following the following recommendations:
- Periodically perform gymnastics to train balance.
- Avoid exposure to toxins and alcohol.
- Cure vascular and neurological pathologies in a timely manner.
- If you have emotional lability, take sedatives and visit a psychotherapist.
- Regularly undergo preventive examinations with a neurologist.
Compliance with these measures will help to avoid diseases accompanied by such an unpleasant phenomenon as dizziness.
A feeling of imaginary rotation and/or translational movements of the patient in various planes, less often - the illusion of displacement of a stationary environment in any plane. In clinical practice, the term “dizziness” is interpreted much more broadly, therefore it includes conditions and sensations caused by disturbances in the receipt of sensory information (visual, proprioceptive, vestibular, etc.) and its processing. The main manifestation of dizziness is difficulty in orientation in space. Dizziness can have a variety of causes. The task of diagnosis is to identify the etiology of dizziness, which subsequently makes it possible to determine the most effective tactics for its treatment.
ICD-10
R42 Dizziness and loss of stability
General information
A feeling of imaginary rotation and/or translational movements of the patient in various planes, less often - the illusion of displacement of a stationary environment in any plane. In clinical practice, the term “dizziness” is interpreted much more broadly, therefore it includes conditions and sensations caused by disturbances in the receipt of sensory information (visual, proprioceptive, vestibular, etc.) and its processing. The main manifestation of dizziness is difficulty in orientation in space.
Etiology and pathogenesis of dizziness
Providing balance is possible by integrating the activities of the vestibular, proprioceptive, visual and tactile systems, which are closely connected with the cerebral cortex and subcortical formations. Histamine, which acts on histamine receptors, plays a critical role in the transmission of information from the receptors of the semicircular canals. Cholinergic transmission has a modulating effect on histaminergic neurotransmission. Thanks to acetylcholine, it is possible to transmit information from receptors to the lateral vestibular nuclei and the central parts of the vestibular analyzer. It has been proven that vestibulovegetative reflexes function due to the interaction of cholinergic and histaminergic systems, and histamine and glutamatergic pathways provide vestibular afferentation to the medial nucleus.
Classification of dizziness
There are systemic (vestibular) and non-systemic dizziness. Non-systemic dizziness includes psychogenic dizziness, presyncope, and imbalance. In some cases, the term “physiological dizziness” may be used. Physiological dizziness is caused by excessive irritation of the vestibular apparatus and occurs as a result of prolonged rotation, sudden changes in movement speed, and observation of moving objects. It is part of motion sickness syndrome.
Systemic dizziness pathogenetically associated with direct damage to the vestibular analyzer. Depending on the level of its damage, central or peripheral systemic vertigo is distinguished. Central is caused by damage to the semicircular canals, vestibular ganglia and nerves, peripheral - by damage to the vestibular nuclei of the brain stem and cerebellum. Within the framework of systemic vertigo, there are: proprioceptive (the feeling of passive movement of one’s own body in space) and tactile or tactile (the feeling of swaying on the waves, lifting or sinking of the body, unsteadiness of the soil, moving support under the feet).
Unsystematic dizziness is characterized by a feeling of instability and difficulty maintaining a certain posture. It is based on a mismatch in the activity of vestibular, proprioceptive, and visual sensitivity, occurring at different levels of the nervous system.
Clinical picture of dizziness
- Systemic dizziness
Systemic dizziness is observed in 35-50% of patients with complaints of dizziness. The occurrence of systemic dizziness is often caused by damage peripheral part vestibular analyzer due to toxic, degenerative and traumatic processes, much less often - acute ischemia of these formations. Damage to higher brain structures (subcortical structures, brain stem, cerebral cortex and white matter) most often occurs due to vascular pathology, degenerative and traumatic diseases. The most common causes of systemic vertigo are vestibular neuronitis, Meniere's disease, benign paroxysmal positional vertigo, and CN VIII neuroma. To determine the nature of the disease already at the first examination of the patient, an adequate assessment of the anamnesis and the results of the clinical examination is necessary.
- Unsystematic dizziness
Balance imbalance can be caused by dysfunction of the vestibular analyzer of various origins. One of the most important distinctive features- deterioration of the patient's condition with loss of vision control (closed eyes). Other causes of imbalance may be damage to the cerebellum, subcortical nuclei, brain stem, multisensory deficit, as well as the use of certain medicines(phenothiazine derivatives, benzodiazepines). In such cases, dizziness is accompanied by impaired concentration and increased drowsiness (hypersomnia). The severity of these manifestations decreases with decreasing dose of the drug.
Pre-fainting states - a feeling of dizziness, ringing in the ears, “darkening in the eyes”, lightheadedness, loss of balance. Psychogenic dizziness is one of the most common symptoms of panic attacks and is one of the most common complaints made by patients suffering from psychogenic disorders (hysteria, hypochondriacal syndrome, neurasthenia, depressive states). It is distinguished by its persistence and pronounced emotional coloring.
Diagnosis and differential diagnosis
To diagnose dizziness, a neurologist must first confirm the fact of dizziness, since patients often put a different meaning into the concept of “dizziness” ( headache, blurred vision, etc.). To do this, in the process of differential diagnosis between dizziness and complaints of a different nature, the patient should not be prompted for one or another term or offered to choose from. It is much more correct to hear from him a detailed description of the existing complaints and sensations.
Much attention should be paid neurological examination patient (CN state, detection of nystagmus, coordination tests, identification of neurological deficit). However, even a full examination does not always make it possible to determine the diagnosis; for this purpose, monitoring the patient over time. In such cases, information about previous intoxications, autoimmune and inflammatory diseases. A patient with dizziness may need consultation with an otoneurologist, vestibulologist and examination of the cervical spine: vestibulometry, stabilography, rotational tests, etc.
Treatment of dizziness
The choice of treatment tactics for dizziness is based on the cause of the disease and the mechanisms of its development. In any case, therapy should be aimed at relieving the patient of discomfort and associated neurological disorders. Therapy of cerebrovascular disorders involves the control of blood pressure, the appointment of antiplatelet agents, nootropics, venotonics, vasodilators and, if necessary, antiepileptic drugs. Treatment of Meniere's disease involves the appointment of diuretics, limiting the intake of table salt, and in the absence of the desired effect and ongoing bouts of dizziness, they decide on surgical intervention. When treating vestibular neuronitis, it may be necessary to use antiviral drugs. Since in case of BPPV the use of drugs that inhibit the activity of the vestibular analyzer is considered inappropriate, the main method of treating benign paroxysmal positional vertigo is the technique of repositioning the aggregates that irritate the vestibular analyzer according to J.M. Epley.
As symptomatic treatment for dizziness, vestibulolytics (betahistine) are used. The effectiveness of antihistamines (promethazine, meclozine) in the case of predominant damage to the vestibular analyzer has been proven. Non-drug therapy is of great importance in the treatment of non-systemic dizziness. With its help, it is possible to restore coordination of movements and improve gait. It is advisable to carry out the therapy of psychogenic dizziness in conjunction with a psychotherapist (psychiatrist), since in some cases it may be necessary to prescribe anxiolytics, antidepressants and anticonvulsants.
Prognosis for dizziness
It is known that an attack of dizziness is often accompanied by a feeling of fear, but dizziness, as a condition, is not life-threatening. Therefore, in the case of timely diagnosis of the disease that caused dizziness, as well as its adequate therapy, in most cases the prognosis is favorable.
Kandyba Dmitry Viktorovichneurologist, doctor of medical sciences, professor of the department of family medicine
Dizziness
Lecture for 6th year students
Saint Petersburg
2017Dizziness is a sensory reaction
expressed in disruption of normal perception
relationship of the body to space with sensation
spatial disorientation and disturbances
stability of the body and its parts
Dizziness
Systemic
Non-systemic
Physiological Systemic dizziness
Systemic (vestibular, true)
dizziness (vertigo) is pathogenetically associated with
dysfunction of the vestibular analyzer and
represents a sensation of imaginary rotation or
translational movement of the patient in various
planes, or illusory displacement of a fixed
environment in any plane
Systemic dizziness is the main
symptom of vestibular syndrome
The cause of dizziness is
acute unilateral or asymmetrical lesion
vestibular analyzer with one-sided
inhibition or irritation of its function The main diseases causing vestibular
(systemic) dizziness
(according to international epidemiological studies)
dizziness (BPPV)
Meniere's disease
Vestibular neuronitis
Labyrinthitis
Migraine-associated dizziness
Unsystematic dizziness
Non-systemic dizziness is not associated with pathology
vestibular analyzer and represents
the following sensations: imbalance and unsteadiness
when standing and walking, lightheadedness,
feeling of “lightheadedness” or “fog in the head”, darkening
before the eyes, disorientation in space
Most often associated with somatic and
psychovegetative diseases, pathological
conditions (hypoglycemia, hyperglycemia, hypoxia,
hypotension, hypoproteinemia, hypovolemia, etc.)
1. Non-vestibular balance disorders:
cerebellar pathology (CVD, hereditary ataxia, etc.);
extrapyramidal diseases (Parkinson's disease and
etc.);
brain stem pathology (neurodegeneration,
CVB, intoxication, consequences of TBI, consequences
neuroinfections, hydrocephalus, etc.);
sensory ataxia (polyneuropathy of the legs, spinal
tabes, myelopathy, funicular myelosis);
taking medications (benzodiazepines,
anticonvulsants, neuroleptics, etc.). The main diseases leading to
development of non-systemic dizziness
2. Presyncope (lipotymic) states:
a sharp decrease in systemic blood pressure (orthostatic
syncope, vasovagal syncope, hypersensitivity
carotid node, paroxysmal cardiac disorders
rhythm and conductivity);
somatic diseases and conditions (hypoglycemia,
anemia, hypoproteinemia, dehydration);
drug overdose, especially in
elderly patients (antihypertensive,
anticonvulsants, sedatives, diuretics,
levodopa drugs, vasodilators,
combination of these drugs in one patient). The main diseases leading to
development of non-systemic dizziness
3. Psychogenic dizziness (occurs when
neurotic and psychovegetative disorders):
agoraphobia;
various phobias;
neurogenic hyperventilation;
other somatoform autonomic disorders
nervous system;
depression;
anxiety;
panic attacks;
hypochondriacal syndrome;
hysteria.
Physiological dizziness occurs when
excessive or unusual irritation
vestibular apparatus and is observed in cases of sudden
changes in movement speed (motion sickness), with prolonged
rotation, observation of moving objects,
being in zero gravity – included in motion sickness syndrome
(kinetosis, seasickness, airsickness)
About 5-10% of people suffer from systematic
motion sickness
When using sea transport, motion sickness
noted by 50-60% of passengers Physiological dizziness
Factors that increase motion sickness:
increased excitability of the sympathetic and
parasympathetic autonomic nervous system,
activation of attention,
neurotic disorder, fear, anxiety,
unpleasant odors and sounds
increase in ambient temperature,
alcohol consumption,
psycho-emotional and intellectual
overwork,
childhood and old age.
Epidemiology of vertigo
In outpatient practice, dizziness occursin approximately 20-40% of people in the general population and is inferior
by prevalence among cerebral symptoms
just a headache
International epidemiological study of causes
dizziness:
32.9% of cases - diseases of the inner ear
21.1% of cases – cardiovascular diseases
11.2% of cases are neurological diseases
(of which only 4% were cerebrovascular diseases)
11% of cases – metabolic disorders
7.2% of cases – mental disorders Vestibular vertigo
With vestibular syndrome, 3 groups are identified
symptoms:
vestibulosensory: sensation of systemic (more often) or
non-systemic (less common) dizziness
vestibulovegetative: nausea, vomiting, hyperhidrosis,
pallor of the skin, changes in blood pressure and heart rate
vestibulosomatic: nystagmus towards the irritated
labyrinth, deviation of the torso and limbs in
opposite side
1. Internal vertigo - dizziness, in which
at rest there is a feeling of imaginary movement
own body or distorted sensation
moving one's own body when moving the head
2. Non-vertiginous dizziness - dizziness, with
in which there is a feeling of disturbance or weakening
spatial orientation, without imaginary or
distorted sense of movement
International classification of vestibular symptoms (Bisdorff A. et al., 2009)
3. Vestibulovisual symptoms - visualsymptoms arising from vestibular pathology
apparatus or its connections: an imaginary sensation of movement or
tilt of surrounding objects, distorted perception
space as a result of vestibular rather than visual
disorders. Dizziness goes away when you close your eyes
3.1. External vertigo - dizziness in which
there is an imaginary sensation of circular motion and
rotation or current movement of surrounding
objects in a certain plane and direction
International classification of vestibular symptoms (Bisdorff A. et al., 2009)
3.2. Oscillopsia - an imaginary sensation of vibrations,jumping, jerking movements of others
objects
3.3. Visual lag (visual delay) - an imaginary sensation
movement of surrounding objects following the movement
heads or their slow movement after stopping
movement (feeling less than 1-2 seconds)
3.4. Visual tilt (visual tilt) – static
perception of the imaginary inclined position of others
objects in relation to the vertical plane (angle
the inclination of objects is fixed and does not change)
3.5. Movement-induced blur (visual blur,
motion-induced) – sense of visual
blurring and decreased visual acuity that occurs during
time or immediately after head movement
International classification of vestibular symptoms (Bisdorff A. et al., 2009)
4. Postural symptoms – balance disorders,which appear in a vertical position, namely
when sitting, standing and walking, and decrease if
the patient tries to hold on to something with his hands
additional support
If confinement is ineffective, then the patient is more likely to
In total, there is vestibular vertigo
Vestibular postural symptoms:
instability and unsteadiness
Directional pulsion
completed fall (Balance-related fall)
Balance-related near fall
Vestibulopathy
PeripheralDefeat
peripheral departments
vestibular
analyzer (semicircular
labyrinth channels,
vestibular ganglion,
vestibular nerve)
Examination and treatment
ENT doctor, otoneurologist,
vestibulologist
Central
Defeat of the central
departments of the vestibular
analyzer
(vestibular nuclei and their
numerous connections,
temporal lobes of the brain)
Examination and treatment
see a neurologist
The main diseases leading to the development of vestibulopathy
PeripheralBenign
paroxysmal
positional
dizziness (BPPV)
Vestibular neuronitis
Meniere's disease or
Meniere's syndrome
Labyrinthitis
Perilymphatic
fistula
Central
Migraine-associated
dizziness
Chr. VBN (DE-II grade)
Stroke in the VBB
Brain stem tumors and
cerebellopontine angle
Head and neck injury
Temporal lobe epilepsy
Multiple sclerosis
Brainstem encephalitis
KVO anomalies
Neurodegenerative diseases
Main diseases leading to damage to the peripheral and central parts of the vestibular analyzer
1. Cerebrovascular diseases2. Consequences of traumatic brain injury
3. Intoxication encephalopathy and vestibulopathy
(including medicinal)
4. Arachnoiditis of the cerebellopontine angle and posterior
cranial fossa
5. DDSD and anomalies of the cervical spine
6. Basilar migraine
vestibulopathy
paroxysmal dizziness in combination with
noise in the ear or hearing loss, congestion
in the ear on the side of the fast component of nystagmus
rotational intense dizziness
dependence of dizziness and appearance
nystagmus from changes in head position
pronounced vestibulo-vegetative reactions
(nausea, vomiting, hyperhidrosis, pallor) Main characteristics of peripheral
vestibulopathy
spontaneous nystagmus of uniform amplitude,
directed in one direction (irritation / destruction),
always binocular, horizontal or
horizontal rotary, depleted during samples
deviation of the torso and limbs (from two
sides) towards the slow component of nystagmus
nystagmus disappears on its own after 2-3
weeks Main characteristics of peripheral
vestibulopathy
the slow phase of nystagmus is directed to the side
affected labyrinth;
nystagmus increases when the eyes are moved to the side
its fast phase (Alexander's law);
Gaze Fixation Suppresses Nystagmus (Study
it is better to carry out with Frenzel glasses);
dizziness often occurs at night while lying down
certain position or in the morning after
awakening;
dizziness usually begins quickly and
short period reaches its maximum.
vestibulopathy
absence of cochlear and autonomic
symptoms
combination with cochlear symptoms
possible only in acute vascular
damage to the brainstem (lateral parts
bridge)
less intense, but longer (days/
months) dizziness, often independent of
changes in head position in space
various types of spontaneous nystagmus:
horizontal, horizontal-rotary,
vertical, diagonal, converging Main characteristics of the central
vestibulopathy
features of nystagmus: uneven
amplitude, may have elements
monocular, directed in both directions,
observed for a long time (months/years), may
change direction when changing
head position, does not become depleted during tests
fixation of gaze does not reduce either nystagmus or
dizziness
the presence of a clearly expressed spontaneous
nystagmus in a patient without complaints of
dizziness indicates central
vestibulopathy Main characteristics of the central
vestibulopathy
disharmonious is observed (remains on
place or deviate towards fast
component of nystagmus) deviation of the hands and
torso
combination of dizziness and loss of consciousness
and focal (defeat cranial nerves,
hemiparesis, etc.) cerebral symptoms
Types of vestibular syndromes
SpicyEpisodic
Chronic
From a few days to From a few seconds
several weeks
up to several hours
From several months
up to several years
Acute disorder
functions
vestibular
analyzer, usually
occurs once
Causes:
Vestibular
neuronitis
Acute labyrinthitis
Stroke in the VBB
Multiple sclerosis
Permanent /
chronic
progressive
disorder
peripheral or
central department
vestibular
analyzer
Causes:
PCF tumor
DE
Cerebellar
degeneration
Transient and
repetitive
attacks of systemic
dizziness and
instability
Causes:
BPPV
Meniere's disease
TIA in VBB
Panic attacks
Vestibular
migraine
EXAMINATION OF A PATIENT WITH VERTIGO
According to the literature, carefully collectedAnamnesis allows us to establish the cause
dizziness with nosological diagnosis
diagnosis in 75% of cases Questions for a patient with a complaint about
dizziness
subjective sensation such as dizziness (systemic,
non-systemic, physiological); in as much detail as possible
describe your feelings associated with the violation
balance without using the term “dizziness”
time of onset of dizziness during the day and its
duration (seconds, minutes, hours, days, months)
constant or paroxysmal dizziness
(duration and frequency of attacks)
dizziness appeared for the first time or it recurs
conditions in which dizziness occurs Questions for a patient with a complaint about
dizziness
factors provoking the occurrence or intensification
dizziness
factors that reduce or stop
dizziness
additional accompanying symptoms combined
with dizziness (tinnitus, hearing loss, nausea,
vomiting, facial pallor, hyperhidrosis, headache
pain, decreased vision, double vision, numbness
face or weakness of the facial muscles, difficulty swallowing and
speech, weakness or numbness in the limbs, impaired
consciousness, involuntary movements or convulsions in
limbs, shortness of breath, palpitations, pain in the area
hearts, etc.)
fainting (history of loss of consciousness) in
moment of dizziness or during the interictal period Questions for a patient with a complaint about
dizziness
presence of other cerebral symptoms during
no dizziness
blood pressure and heart rate levels during dizziness
presence of chronic neurological,
otorhinolaryngological, somatic or
history of endocrine disease
TBI, cervical trauma, infection, ARVI, otitis - in
next 3 months
list and dose of constantly taken or recently taken
prescribed medications
subjective assessment of one's psycho-emotional
conditions in the next 3 months (stress, conflict
situations, condition emotional sphere, violations
sleep, level of anxiety and psychological tension,
phobias) Basics of clinical examination in
dizziness (for general practitioner)
Measuring blood pressure and heart rate (lying and sitting)
Auscultation of the heart and bifurcation of the carotid arteries
A brief physical examination (especially relevant when
non-systemic dizziness): auscultation of the heart and lungs,
palpation of the abdomen, Pasternatsky's symptom, etc.
Neurological status examination: cranial nerves
(especially the function of the cochleovestibular nerve), deep reflexes,
strength and sensitivity in the limbs, cerebellar functions,
palpation of the cervical spine, meningeal symptoms
Otorhinolaryngological examination (necessary for
peripheral vestibulopathy and cochlear symptoms)
Special vestibular clinical diagnostic
tests: Dix-Hallpike, Halmagi, Unterberger, etc.
Special autonomic diagnostic tests
(performed for non-systemic dizziness): orthostatic
test, clinostatic test, Dagnini-Aschner test, etc. Nystagmus - involuntary fast rhythmic
oscillatory eye movements
The direction of nystagmus in vestibulopathy is determined
according to its fast phase
In case of damage (suppression) of the vestibular apparatus with
on one side the slow phase of nystagmus is directed towards
side of the affected ear, and the fast phase of nystagmus in
side of the healthy ear
With irritation (irritation) of the labyrinth
the direction of the nystagmus phases is opposite
During acute vestibular vertigo
there is a sensation of movement or rotation
surrounding objects in the opposite
direction from the affected labyrinth and in the direction
fast phase nystagmus
Nystagmus almost always increases with abduction
eye towards its fast phase Visual characteristics of nystagmus
Direction (assessed by the fast component of nystagmus,
which is directed towards the irritation of the labyrinth or towards the healthy
side when the function of one labyrinth is inhibited)
Plane (horizontal, vertical, diagonal,
rotatory)
Amplitude (small-span, medium-span,
large-scale)
Frequency (number of shocks in a certain time, brisk, slow)
Force:
I degree - nystagmus is detected only when looking towards it
fast component;
II degree - nystagmus is detected when looking not only to the side
fast component, but also when looking straight;
III degree – nystagmus persists even when looking to the side
slow component
severity of components (clonic - normal alternation
fast and slow phases, tonic-clonic or tonic -
prolongation of the slow phase of nystagmus, occurs with central
vestibulopathy)
Romberg test
The subject is in a position
standing with legs tightly together
(toes and heels should touch),
straight arms extended forward in front
himself and closes his eyes
Vestibular ataxia:
The patient leans to the side
affected labyrinth - to the side
slow component of spontaneous
nystagmus
For peripheral vestibulopathy
the direction of deflection changes
body when changing head position Diagnostic tests for dizziness
Unterberger test (Fukuda step test)
The patient stands in the Romberg position with eyes closed and arms extended
forward, holding them horizontally
Next, the subject is asked to take 100 steps in one place.
or walk for one minute, as high as possible
knees up
If there is one-sided
vestibular dysfunction patient in
walking time gradually rotates
around its axis, turning in
side of the affected labyrinth
The sample is considered positive when
turning sideways more than 45°
For more visual objectification
angle of rotation for a given test,
draw a circle with a diameter of 1 meter and
divide it into radial sectors,
and the patient becomes the center of the circle Diagnostic tests for dizziness
Babinski-Weil test (star test)
The patient with his eyes closed does five times
steps forward and, without turning, five steps back
straight line, within 30 seconds
If there is one-sided
vestibular lesion, then
the patient's route will be
be shaped like a star
deviation from
original direction
sometimes up to 90° or more in
pathological side
process Diagnostic tests for dizziness
Used to diagnose peripheral
vestibulopathy - BPPV (otolithiasis) – complaints of
positional vertigo, including lying down
To conduct the test, the subject must sit on a couch,
fixing your gaze on the doctor's forehead
The doctor turns the patient’s head 45° to the side, and then
holding the head with his hands, quickly lays the patient on his back, so
so that the head hangs back 20–30° below the level of the couch
This movement must be fast enough and should not
take more than 3 seconds
The doctor observes the patient's eye movements for at least 20
seconds in the absence of nystagmus and longer if it appears
The procedure is repeated with the head turned in the opposite direction.
side Diagnostic tests for dizziness
Dix-Hallpike test (Nilen-Barany) Diagnostic tests for dizziness
Dix-Hallpike test (Nilen-Barany)
A diagnostic test is considered positive if
positional vestibular vertigo occurs,
accompanied by horizontal rotatory nystagmus
and lasting 20-40 seconds
When the posterior semicircular canal is damaged,
rotatory nystagmus directed towards the underlying ear
With damage to the horizontal semicircular canal also
horizontal nystagmus towards the underlying ear is noted.
Distinctive features of the peripheral
positional nystagmus are the presence of latent
period (usually lasting several seconds),
fading nature of nystagmus (as a rule, it
lasts less than 1 minute, more often – 15–20 seconds) and
vertical-torsional or horizontal direction Diagnostic tests for dizziness
For a patient who is in
sitting position, offer
fix your gaze on
bridge of the nose
there's a doctor in front of him
Examiner quickly
turns the patient's head
alternately one and the other
side approximately 15-20° from
middle line
OK thanks
compensatory movement
eye in the opposite
direction of the eyes remain
fixed on the bridge of the nose
doctor and do not move after
turning the head (Fig. A)
A
IN Diagnostic tests for dizziness
Halmagi test (study of horizontal
vestibulo-ocular reflex)
If the function of one of the
labyrinthine eyes are returning
to the starting position with
late - after
head turning occurs
corrective saccade,
allowing you to return your gaze to
starting position (Fig. B)
Positive Halmagi test
highly specific for
peripheral
vestibulopathy (in acute
dizziness)
With central
vestibulopathy this test
negative
A
IN Benign paroxysmal positional
dizziness (BPPV)
According to foreign literature, this species
dizziness occurs in 17-35% of cases among
patients with peripheral vestibulopathy and is
most common vestibular disease
The average age of patients with BPPV is 50-70 years
BPPV is associated with the movement of otolith fragments into
endolymphatic space of the semicircular canals
labyrinth, which is called canalolithiasis or
cupulolithiasis Benign paroxysmal positional
dizziness (BPPV)
Clinic of BPPV - paroxysmal short-term
systemic dizziness that always occurs when
a certain head position, which
accompanied by nausea and other vegetative
symptoms, as well as nystagmus
The attack lasts 30-60 seconds and goes away spontaneously
Provocative movements are: turning the head
and torso in bed, adopting a horizontal
body position from vertical or vice versa, tilt
head and torso forward and down, throwing back
heads back
BPPV rarely occurs in a standing or sitting position and when
he has no cochlear symptoms Meniere's disease
Meniere's disease is detected in 5.9% of patients with a complaint
for dizziness
According to the literature, Meniere's disease affects about
0.1% of the total European population
The main morphological substrate of the disease is
is endolymphatic hydrops (hyperproduction
endolymph and a decrease in its resorption with an increase
intralabyrinthine pressure)
In 85% the disease is unilateral, but in the future
about 30-50% of patients report a transition
pathological process on the opposite side
The median age at which Meniere's disease develops is 30 to 50 years. Meniere's disease
Clinic of Meniere's disease: attacks of severe
systemic dizziness, progressive decline
hearing, fluctuating noise in the ear, a feeling of fullness and
ear pressure
The duration of the attack is variable and most often
lasts several hours (from minutes to several days)
During the interictal period, subjective
the patient feels completely healthy during the examination
experimental vestibular is recorded
normoreflexia Meniere's disease
Diagnostic criteria for Meniere's disease
criteria of the American Academy of Otolaryngology and
head and neck surgery (definite Meniere's disease):
history of 2 or more attacks of dizziness,
occurring spontaneously and ongoing 20
minutes or more
hearing loss or deterioration develops, which is at least
once confirmed by audiological data
research (audiometry)
there is noise in the ear, a feeling of fullness occurs
or fullness in the affected ear
other reasons for the development of vestibular and
cochlear disorders Meniere's disease
Classification of Meniere's disease:
1. Cochlear form of Meniere’s disease, in which
the disease begins with hearing disorders,
occurs in 50% of cases
2. The classic form of Meniere's disease, in which
a simultaneous disorder of the vestibular and
auditory function, noted in 30% of cases
3. Vestibular form of Meniere’s disease, in which
the disease begins with vestibular disorders,
noted in 20% of cases Vestibular neuronitis
Vestibular neuronitis is the third most common
cause of peripheral vestibulopathy, after BPPV and
Meniere's disease and occurs in 4.3% of patients with
complaint of dizziness
Most often, vestibular neuronitis develops acutely/
subacutely against the background of or immediately after acute respiratory viral infection,
mainly in patients aged 30-60 years
The etiopathogenesis of vestibular neuronitis is associated with
selective viral or infectious-allergic
inflammation of the vestibular nerve Vestibular neuronitis
Clinic: attack of acute systemic dizziness with
nausea, vomiting, unsteadiness when walking
Duration of dizziness from several hours to
several days
Systemic dizziness worsens with movement
head or change in body position, accompanied
spontaneous horizontal rotatory nystagmus and in a number
cases of oscillopsia
Unlike BPPV, which also causes dizziness
intensifies with head movements, with vestibular
neuronitis dizziness does not go away even with rest
Hearing loss is usually not observed. Maybe
there is noise and congestion in the ear with normal
audiological examination indicators ACVA in the vertebrobasilar region
Central vestibulopathy often develops with
damage to the vestibular nuclei of the brain stem and
their numerous connections, which is accompanied by
only vestibular, but also other focal
neurological symptoms:
– visual symptoms (double vision, homonymous hemianopia, cortical
visual agnosia),
– static-locomotor and dynamic cerebellar ataxia,
– dysfunction of the cranial nerves (usually the bulbar group),
– motor and sensory disturbances in opposite directions
limbs according to alternating type,
– attacks of falling and fainting,
– cervical-occipital headache,
– memory impairment
– Horner's syndrome
– paresis of horizontal gaze ACVA in the vertebrobasilar region
Ischemic vascular lesion of the labyrinth with
clinical picture of peripheral vestibulopathy
Rarely occurs with VBI
Acute vestibular syndrome with symptoms
peripheral vestibulopathy can develop:
– with isolated lacunar lesion of the pons
in the area of the vestibular nuclei;
– with local ischemic focal lesions
nodule (nodulus) of the cerebellum
Isolated systemic dizziness is practically not
occurs in cerebrovascular diseases, and in
most cases are caused by diseases
inner ear with peripheral vestibulopathy Treatment for dizziness
Treatment of non-systemic dizziness
is a complex therapy
main etiological disease,
syndrome or pathological condition
Vestibular suppressants for
non-systemic dizziness
are ineffective and their purpose in data
patients are not recommended Treatment for dizziness
dizziness:
1. Vestibular suppressants (used in the treatment
acute vestibulopathy, use no more than 3 days):
Dimenhydrinate (dramine) tab. 50 mg, 50 mg 3-4 times
per day, no more than 400 mg per day;
Meclozine (Bonine) tab. 25 mg, 12.5-25 mg 3-4 times a day
day, no more than 100 mg per day;
Promethazine (pipolfen) etc. 25 mg, amp. 2 ml (50 mg)
12.5-25 mg 3-4 times a day or IM 1 ml 25 mg
once, no more than 150 mg per day;
Lorazepam (lorafen, merlit) tab. 1 mg, tab. 2.5 mg, by
1-2.5 mg 1-2 times a day, no more than 5 mg per day;
Diazepam (Relanium, Sibazon, Seduxen) tab. 5 mg, by
2.5-5 mg 1-2 times a day, or 5-10 mg (1-2 ml) IM
once, no more than 20 mg per day. Treatment for dizziness
Symptomatic therapy for systemic
dizziness:
2. Antiemetics (used for acute
vestibulopathy, use no more than 3 days):
Metoclopramide (cerucal) tab. 10 mg, amp. 2 ml (10 mg),
10 mg 1-3 times a day or 2 ml 10 mg intramuscularly once,
no more than 30 mg per day;
Thiethylperazine (torecan) tablets 6.5 mg, suppositories
6.5 mg, amp. 1 ml (6.5 mg), 6.5 mg orally or rectally
1-3 times a day, or 1 ml (6.5 mg) intramuscularly
once, no more than 20 mg per day;
Ondansetron (zofran, latran) tab. 4 mg, tab. 8 mg,
amp. 2 ml (2 mg), 50 ml bottles (5 ml 4 mg),
suppositories 16 mg, 4-8 mg 2 times a day, or
intramuscularly 4-8 mg, no more than 24 mg per day. Treatment for dizziness
Additional funds (can be used for
improving vestibular compensation in rehabilitation
period of treatment of vestibulopathy):
Betahistine dihydrochloride (betaserc, vestibo,
betaver, tagista) tab. 8 mg, 16 mg, 24 mg, 24 mg 2 times
per day for 1-2 months;
Ginkgo biloba – EGb - 761 (tanakan, memoplant) tab.
40 mg, 80 mg, 40-80 mg 3 times a day for 1-2
months;
Cinnarizine (stugeron) tab. 25 mg, 25-50 mg 3 times a day
day for 1-2 months;
Piracetam (nootropil) caps. 400 mg, 400-800 mg – 23 times a day for 1-2 months. Treatment for dizziness
Pathogenetic therapy of systemic
dizziness is determined by nosological
belonging to vestibular syndrome:
for peripheral vestibular syndrome treatment
is agreed with the ENT doctor and otoneurologist /
vestibulologist;
for central vestibular syndrome - with a neurologist;
acute pathology of the inner ear or acute central
vestibulopathy with focal neurological
symptoms – urgently call an ambulance and
hospitalization. Pathogenetic treatment of BPPV
o The basis of treatment and prevention of BPPV is
special vestibular maneuvers (Epley, Brandt-Daroff, Semont, Lempert, etc.), which represent
involves turning the patient's head and torso,
produced in a certain sequence and
pace, which leads to the return of otoliths from the semicircular
channel into the pouch
o The literature provides data on complete cure of 83%
patients with BPPV after a single vestibular
maneuver performed by a specialist (otoneurologist,
vestibulologist)
o From drugs in the treatment of BPPV
vestibular suppressants are used and
antiemetics, as well as betahistine
dihydrochloride Pathogenetic treatment of Meniere's disease
o To relieve an attack of dizziness during illness
Meniere is used: vestibulosuppressors, for example
dimenhydrinate and benzodiazepine tranquilizers
o To prevent attacks, the following is used:
o 1) salt-free diet (no more than 1.5 g of salt per day);
o 2) diuretics, such as azetazolamide or
hydrochlorothiazide, triamterene;
o 3) betahistine dihydrochloride
o If there is no effect within 6 months –
surgical treatment (drainage and decompression
endolymphatic sac) Pathogenetic treatment of vestibular
neuronitis
o In the treatment of vestibular neuronitis the following is used:
o sanitation of foci of chronic infection
o vestibulosuppressors
o antiviral and other drugs (depending on
from the etiology of neuronitis)
o corticosteroids
o detoxifying agents
o Methylprednisolone is considered the drug of choice in
initial dose of 100 mg per day followed by reduction
doses of 20 mg every 2 days Non-drug treatment and prevention
o Elimination of drug intoxication
vestibular and auditory analyzers:
streptomycin, kanamycin, gentamicin, furosemide,
ethacrynic acid, phenobarbital, carbamazepine,
indomethacin, butadione, amitriptyline, imipramine, etc.
o Normalization of lifestyle: it is necessary to exclude
smoking and drinking alcohol, normalizing nutrition and
weight loss for obesity, regular dynamic
aerobic physical activity, normalization of the regime
sleep, blood pressure and heart rate control
o Rehabilitation in the form of vestibular gymnastics
(Brandt-Daroff methods, etc.). Wherein
vestibular compensation occurs faster in
patients with peripheral vestibulopathy
G dizziness is one of the symptoms most often encountered in medical practice. Among the reasons for visiting doctors of all specialties, it accounts for 2-5%.
The cause of dizziness is an imbalance of sensory information coming from the main afferent systems that provide spatial orientation - vestibular, visual and proprioceptive. Disturbances in central information processing and the efferent part of the motor act are also of great importance. In addition, pathology of the musculoskeletal system plays a certain role.
In most cases Dizziness is based on one of the following conditions : peripheral vestibular disorders, multiple sensory deficits, psychogenic causes, circulatory disorders in the brain stem, other diseases of the central nervous system, cardiovascular diseases. There may be a combination of several reasons.
Patients can describe a wide variety of sensations as “dizziness,” so the primary diagnostic task is to clarify the nature of the patient’s complaints. Typically, they can be classified into one of four clinical types of vertigo.
Systemic or vestibular vertigo - a feeling of spinning, falling, tilting or swaying of your own body or surrounding objects. Often accompanied by nausea, vomiting, hyperhidrosis, impaired hearing and balance, as well as oscillopsia (the illusion of rapid small-amplitude vibrations of surrounding objects). Systemic vertigo is characteristic of damage to the vestibular system - both its peripheral and central parts.
Pre-fainting state . Patients note a feeling of lightheadedness, impending loss of consciousness, and “lightness” in the head. Often combined with pallor of the skin, palpitations, a feeling of fear, darkening of the eyes, nausea, and increased sweating. The most common causes are heart disease and orthostatic hypotension.
In some cases, by “dizziness” patients mean imbalance . There is instability, unsteadiness when walking, and a “drunk” gait. It is characterized by a combination with paresis, sensitivity disorders, incoordination and oscillopsia. Symptoms caused by imbalance occur when standing and walking and are absent when sitting or lying down.
For psychogenic dizziness observed, in particular, within the framework of anxiety, conversion disorders or depression, characterized by difficult-to-describe sensations that do not correspond to the previous types of dizziness. Patients may complain of “fog,” “heaviness” in the head, a feeling of intoxication, and lightheadedness. It should be noted that similar vague symptoms may occur in the early stages or with an atypical course. organic diseases.
Along with the clinical type of dizziness, its course, the presence of provoking factors and accompanying symptoms. A single episode of systemic vertigo is most often caused by a brainstem or cerebellar stroke. Repeated attacks of dizziness can develop either for no apparent reason or due to certain provoking factors. Spontaneous attacks of dizziness, not provoked by sudden movements of the head, usually serve as a manifestation of arrhythmias, transient ischemic attacks (TIA) in the vertebrobasilar region, Meniere's disease or epileptic seizures. Recurrent attacks of dizziness, in which provoking factors are identified (changes in body position, turning the head), are most often caused by benign paroxysmal positional vertigo (BPPV) or fainting, in particular orthostatic.
Systemic dizziness Most common cause systemic vertigo is BPPV. The disease usually develops after middle ear infections, traumatic brain injury, or otological surgery. Characteristic are short-term (no more than 1 minute) attacks of systemic dizziness that occur when changing body position. In the pathogenesis of BPPV, the leading role is played by cupulolithiasis - the formation of a clot of calcium carbonate crystals in the cavity of the semicircular tubule, which leads to an increase in the sensitivity of the receptors of the semicircular tubules. To identify positional vertigo, a test is performed Nilena-Barani
. From a sitting position, the patient quickly lies on his back, with his head tilted back 45° and turned to the side 45°. The position is maintained for 30-40 seconds. The test is repeated with the head positioned along the midline and when turned in the opposite direction. The development of positional vertigo and nystagmus confirms the diagnosis. Isolated positional nystagmus also speaks in favor of BPPV - during fixation eyeballs in the middle position, the nystagmus is vertical-rotatory, with a fast phase directed upward and towards the underlying ear. When looking towards the underlying ear, the fast phase of nystagmus is directed in the same direction, horizontal-rotatory nystagmus, when looking in the opposite direction - vertical, beating upward. There is a characteristic latent period (30-40 seconds) between the start of the test and the onset of nystagmus. The nystagmus fades when the test is repeated. Positional nystagmus is observed inconsistently, more often during an exacerbation. BPPV must be differentiated from central positional vertigo and nystagmus, the most common causes of which include spinocerebellar degenerations, brainstem tumors, Arnold-Chiari malformation, multiple sclerosis. Central positional nystagmus has no latent period, its duration exceeds 1 minute, the direction of nystagmus can vary, often vertical nystagmus does not fade with repeated examination. To treat BPPV, exercises are used to move calcium carbonate crystals from the semicircular tubule into the cavity of the elliptical sac. Repeated provocation of dizziness is also effective, which leads to its gradual regression due to central compensation.
The combination of systemic dizziness with focal neurological symptoms is characteristic of circulatory disorders in the vertebrobasilar system, as well as tumors of the cerebellopontine angle and posterior cranial fossa. With vertebrobasilar insufficiency, dizziness usually develops suddenly and persists for several minutes, often accompanied by nausea and vomiting. As a rule, it is combined with other symptoms of ischemia in the vertebrobasilar region. Early stages of vertebrobasilar insufficiency may present with episodes of isolated systemic vertigo. Longer episodes of isolated systemic vertigo suggest other diseases, particularly peripheral vestibular disorders. Along with systemic vertigo, TIAs and strokes in the vertebrobasilar region may also present with balance disorders.
Systemic dizziness, nausea and vomiting are the earliest symptoms of ischemia in the anterior inferior cerebellar artery. , leading to the development of infarction of the caudal parts of the tegmentum of the pons (lateral inferior pontine syndrome, Gasperini syndrome). Similar symptoms are observed with cerebellar infarction. Such symptoms require a differential diagnosis with peripheral vestibular disorders. With damage to the cerebellum, in contrast to damage to the labyrinth, the fast component of nystagmus is directed towards the lesion. Its direction changes depending on the direction of gaze, but nystagmus is most pronounced when looking in the direction of the lesion. Fixing the gaze on any object does not affect nystagmus and dizziness. In addition, there is discoordination in the limbs, which is absent when the labyrinth is affected.
Acute systemic dizziness, both isolated and in combination with suddenly developed deafness, is characteristic of infarction of the labyrinth . Deafness caused by labyrinthine infarction is usually irreversible, while the severity of vestibular disorders gradually decreases. A combination of labyrinthine and brainstem infarction is possible.
Systemic dizziness is a cardinal symptom of peripheral vestibular disorders . The most important sign that makes it possible to differentiate peripheral vestibular disorders from central ones is nystagmus - most often horizontal, directed in the direction opposite to the lesion and intensifying when looking in the same direction. Unlike a central lesion, gaze fixation reduces nystagmus and vertigo.
Acute development of systemic dizziness in combination with nausea and vomiting is typical for viral neurolabyrinthitis (vestibular neuronitis, vestibular neuritis). Symptoms usually regress within a few days, in severe cases - after 1-2 weeks. Typically, symptoms develop 1-2 weeks after respiratory infection.
Meniere's disease manifests itself as repeated episodes of severe systemic dizziness, accompanied by decreased hearing, a feeling of fullness and noise in the ear, nausea and vomiting. Within a few minutes, the dizziness reaches its maximum and gradually, over the course of several hours, goes away. Hearing impairment in the early stages of the disease regresses completely and then becomes irreversible. Balance problems may occur for several days after an attack of Meniere's disease. The first attacks of the disease may manifest as isolated systemic dizziness. To confirm the diagnosis, audiometry is performed. A hearing loss of more than 10 dB at two different frequencies is typical. The cause of Meniere's disease is recurrent swelling of the labyrinth, which develops as a result of rupture of the membrane separating the endolymph from the perilymph.
Treatment
Treatment of systemic dizziness is largely determined by its cause; in addition, symptomatic therapy plays an important role. Specific treatment for systemic vertigo is known only for a limited range of diseases. Dizziness as part of vertebrobasilar insufficiency requires prescription antiplatelet agents (acetylsalicylic acid 75-330 mg/day, ticlopidine 500 mg/day), and if symptoms increase - anticoagulants. For viral neurolabyrinthitis, symptomatic therapy is carried out. The effectiveness of antiviral drugs and glucocorticoids has not been proven.
Treatment of attacks of Meniere's disease is symptomatic. Most effective betahistine . For prevention, a low-salt diet and diuretics are prescribed.
For the symptomatic treatment of systemic dizziness, vestibulolytic agents are used that act on vestibular receptors or on central vestibular structures, mainly the vestibular nuclei. The first ones are antihistamines : meclozine is prescribed 12.5-25 mg orally 4 times a day, promethazine - 25-50 mg orally, intramuscularly or rectally 4-6 times a day. Have a central vestibulolytic effect benzodiazepines : oxazepam - 10-15 mg orally 4 times a day, diazepam - 5-10 mg orally, IM or IV 4-6 times a day. A stimulant is also used histamine receptors betahistine - 8-16 mg orally 2-3 times a day, calcium antagonists (cinnarizine 25-50 mg orally or intramuscularly 4 times a day, flunarizine 10 mg per day in the afternoon).
An effective remedy for the treatment of dizziness is combination drug Fezam , containing 400 mg of piracetam and 25 mg of cinnarizine. The effect of the drug is complex, including vasoactive and metabolic effects. The combination of two components in the drug leads to their enhancement therapeutic effect without increasing toxicity. In addition, Phezam was noted to be more effective and tolerable compared to separate administration of its components.
A number of double-blind, placebo-controlled studies have shown high efficiency Phezam for systemic vertigo caused by both central and peripheral vestibular disorders. The drug also reduced the severity of dizziness during the presyncope state. Fezam is effective in patients with chronic cerebrovascular insufficiency, who showed significant improvement in cognitive functions during treatment. The drug is prescribed 2 capsules 3 times a day for 3-6 weeks.
For relief of nausea and vomiting Prescribe prochlorperazine 5-10 mg orally or intramuscularly 4 times a day, 25 mg rectally once a day or metoclopramide - 5-50 mg orally, intramuscularly or intravenously 4-6 times a day. Thiethylperazine has a central vestibulolytic and antiemetic effect. Prescribe 6.5 mg orally, rectally, subcutaneously, intramuscularly or intravenously 1-3 times a day. A combination of antihistamines and benzodiazepines is effective. To reduce the sedative effect of vestibulolytic drugs, it is recommended to prescribe methylphenidate hydrochloride 5 mg orally 2 times a day (in the first half of the day). Vestibulolytic agents should be prescribed only for acute systemic dizziness. Their use should be as short as possible, since long-term use slows down the process of central compensation of the defect.
The main principle of rehabilitation for peripheral vestibular disorders is stimulation of central compensation by repeated stimulation of vestibular receptors. It is necessary to start rehabilitation as early as possible. When the central vestibular structures are damaged, rehabilitation is much less effective.
Balance imbalance One of the causes of imbalance is chronic vestibular dysfunction. Characteristically, symptoms intensify in the dark, when it is impossible to compensate for the defect with the help of vision. Oscillopsia is often observed, possibly combined with hearing impairment. The most common cause of chronic bilateral labyrinthine lesions is the use of ototoxic drugs. Worsening imbalance in the dark is also characteristic of deep sensitivity disorders. The most pronounced imbalances develop in cerebellar disorders. Visual control does not affect the severity of symptoms. With damage to the flocculonodular parts of the cerebellum, oscillopsia is often observed, as well as nystagmus, depending on the direction of gaze. One of the mechanisms of imbalance is also disorders of cervical proprioception. The causes of imbalance caused by changes in the efferent part of the motor act include multiple subcortical infarctions, normal pressure hydrocephalus, Parkinson's disease, chronic subdural hematoma, tumors frontal lobes, as well as a number of medications - anticonvulsants (difenin, phenobarbital, finlepsin), benzodiazepines, neuroleptics (phenothiazines, haloperidol), lithium preparations. Balance imbalance - characteristic symptom tumors of the cerebellopontine angle, temporal bone and posterior cranial fossa. Systemic dizziness is observed much less frequently with this pathology. In the vast majority of cases, concomitant neurological symptoms are detected. In addition, one of the causes of imbalance, observed mainly in the elderly, is multiple sensory insufficiency - a combination of moderate disorders of several sensory functions. Disturbances in the central integration of sensory information play a certain role in its development.
Psychogenic dizziness Psychogenic dizziness most often occurs as part of agoraphobia, depression and panic attacks, and also, usually in the form of a pre-fainting state, serves as a manifestation of hyperventilation syndrome. With dizziness of an organic nature, it is also possible to develop restrictive behavior, in particular, secondary agoraphobia or reactive depression. In some cases, there is a combination of episodes of organic and psychogenic dizziness, as well as the development of dizziness of mixed origin. Treatment is determined by the nature of the underlying disorder. Psychotherapy is of great importance. It is necessary to explain to the patient the essence of his existing disorders, since often an additional psychotraumatic factor is the belief that he has a life-threatening disease.
The list of references can be found on the website http://www.site
Piracetam + Cinnarizine -
Fezam (trade name)
(Balkanpharma)
Literature:1. Weiss G. Dizziness // Neurology Edited by M Samuels - M, Practice, 1997-C 94-120.
2. Lavrov A.Yu., Shtulman D.R., Yakhno N.N. Dizziness in the elderly // Neurological journal -2000 -T 5, N 5 -S 39-47.
3 Lavrov A.Yu. Application of betaserc in neurological practice // Ibid -2001 -T6.N2-C35-38.
4. Baloh R.W. Dizziness in older people//J Am Genatr Soc-1992-Vol 40, N 7 -P 713-721.
5. Baloh R.W. Dizziness and verigo // Office practice of neurology Eds M A Samuels, S Feske - New York, 1996 - P 83-91.
6. Baloh R.W. Vertigo //Lancet -1998 -Vol 3 52 -P 1841-1846..
7. Ban T. Psychopharmacology fot the aged - Basel, Karger, 1980.
8. Brandt T. Vertigo // Neurological disorders Course and treatment Eds T Brandt, L P Caplani, J Dichgans et al -San Diago, 1996 -P 117-134.
9. Daroff R.V., Martin J.B. Dizziness and vertigo // Harrison’s principles of internal medicine Eds Fauci A.S., Braunwald E., Isselbacher K.J. et al -14th ed - New York, 1998-P 104-107.
10. Davies R.A. Disorders of balance // Handbook of vestibular rehabilitation Eds L.M. Luxon, R.A. Davies -London, 1997 -P 31-40.
11. Derebery M.J. The diagnosis and treatment of dizziness // Med Clin North Am -1999-Vol 83,N 1 -P 163-176.
12. Drachman D.A. A 69-year-old man with chronic dizziness // JAMA -1998 -Vol 290, N 24-Р21П-2118.
13. Fraysse V., Bebear J.P., Dubreuil S. et al Betahistine dihydrochloride versus flunarizine A double-blind study on recurrent vertigo with or without cochlear syndrome typical of Memere's disease // Acta Otolaryngol (Stockh) - 1991 - Suppi 490-P 1 -10.
14 Furman J.M., Jacob R.G. Psychiatric dizziness // Neurology-1997-Vol 48, N 5-P 1161-1166.
15 Gomez S.R. , Cruz-Flores S., Malkoff M.D. et al. Isolated vertigo as a manifestation ofvertebrobasilar ischemia // Neurology -1996 -Vol 47 -P 94-97.
16. Hollander J. Dizziness//Semin Neurol-1987-Vol 7, N 4-P 317-334.
17. Konstantinov K., Yordanov Y. Clinical and experimental-psychological studies in cerebral atherosclerosis //MBI-1988-Vol 6-P 12-17.
18. Luxon LM. Modes of treatment of vestibular symptomatology // Handbook of ves-tibular rehabilitation Eds L.M. Luxon, R.A. Davies -London, 1997 -P 53-63.
19.Popov G., Ivanov V., Dimova G. et al Phezam - clinical and psychoogical study // MBI-1986-Vol 4-P3-6.
20. Temkov I. Yordanov Y., Konstantinov K. et al. Clinical and experimental-psuchological studies of the Bulgarian drug pyramem // Savr Med-1980-Vol 31, N9 -P 467-474.
21. Troost T.V. Dizziness and vertigo // Neurology in clinical practice Eds W.G. Bradley, R.W. Daroff, G.M. Fenichel, S.D. Marsden 2nd ed -Boston, 1996 -P 219-232.
Many people periodically complain of dizziness. This condition significantly worsens a person’s health and negatively affects his mental state.
Dizziness in itself is not a disease - it is only a symptom of various pathologies.
In any case, if such disorders occur, you should consult a doctor who will conduct a thorough diagnosis.
Moreover, it is very important to establish the type of dizziness, which can be vestibular and non-systemic.
- All information on the site is for informational purposes and is NOT a guide to action!
- Can give you an ACCURATE DIAGNOSIS only DOCTOR!
- We kindly ask you NOT to self-medicate, but make an appointment with a specialist!
- Health to you and your loved ones!
Symptoms
Non-systemic or, as they are also called, pseudo-dizziness are observed much more often than systemic ones and can be of different types.
| 1 type | This category includes lipothymic states, which can be called presyncope. In this case, the person complains of the following symptoms:
This condition is explained by the development of orthostatic hypotension, which consists of a sharp decrease in blood pressure. It is especially often observed when there is a sudden change in body position from horizontal to vertical. This condition usually does not last long, and the person recovers quickly.
In addition, the following factors can lead to the development of dizziness:
|
| Type 2 |
|
| 3rd view | This category includes psychogenic dizziness. The most common sources of such deviations are panic disorders and increased anxiety. Panic attacks are characterized by a sudden feeling of fear that cannot be explained. Typically in such situations the following symptoms occur:
Psychogenic dizziness can be observed constantly and felt for many months, or even years. They often appear with all sorts of mental disorders - for example, they become a symptom of a depressive state. Determining the causes of such dizziness can be quite difficult. |
Diagnostics
A number of tests are carried out to diagnose dizziness and determine its causes. First, the patient must describe a typical attack. When collecting anamnesis, the doctor should find out the duration of dizziness, the connection with changes in body position, the presence of nausea, vomiting and other associated symptoms.
Be sure to measure arterial pressure in vertical and horizontal position. If in an upright position it decreases significantly, we can talk about the development of a lipothymic state.
Important diagnostic criterion is also the presence of nystagmus - this condition consists of involuntary oscillation of the eyeballs. This problem may be associated with a change in head position.
An otolaryngologist may perform special temperature tests. In this case, the ear canal is irrigated with water, the temperature of which is seven degrees higher or lower than the temperature of the blood. Such studies can provoke nystagmus and a sensation of rotation of the torso.
The doctor may also perform rotational testing. In this case, the person is rotated on a special chair and the movements of the eyeballs are recorded.
Recently, a study of the tracking function of the eyes has begun to be used, which is carried out in the presence and absence of visual interference. The promise of this testing is associated with the close interaction of the vestibular and visual systems.
Treatment of non-systemic dizziness
For treatment of non-systemic dizziness to be effective, it must include medicinal and non-medicinal means. In any case, first of all it is necessary to establish the cause of the development of this condition.
According to the research results, it was found that the use this tool helps to significantly reduce psychovegetative disorders and significantly improve a person’s quality of life.
With the development of psychogenic dizziness, psychological support for a person is of no small importance. If he has depressive or neurotic disorders, antidepressants or anxiolytics are used. However, this is carried out only after consultation with a psychiatrist or neurologist.
If dizziness occurs constantly, you should immediately consult a doctor. After all, this condition may indicate the development dangerous disease, which poses a real threat to life.
Non-systemic dizziness is a fairly serious disorder that worsens a person’s quality of life and is accompanied by a number of unpleasant symptoms.
To prevent dangerous complications and improve your health, you should immediately consult a doctor. Only a specialist will be able to conduct a detailed examination that will help determine the causes of dizziness and select adequate therapy.
