Vertigo is a movement or positional illusion caused by the body’s obstacles to spatial positioning.
Vertigo usually involves the internal imbalance of the vestibular system, and the symptoms themselves cannot be located in the inner ear, the stretch receptors deep next to the cervical spine, the vestibular center, the cerebellum, the brain pathways or the cortex.
A preliminary distinction can usually be made between peripheral and central vertigo based on the medical history.
Peripheral vertigo is usually severe, rotational, and often associated with other physiological changes, such as hearing loss, ear diseases, and autonomic nervous reactions such as vomiting.
Central vertigo is usually of moderate severity and is continuous. It usually refers to balance disorders, the patient has a tendency to fall, and the limbs are weak.
When describing vertigo, the degree of vertigo, the duration of the symptoms (tinnitus, frequency of attacks, reasons or incentives for aggravation or remission, related hearing loss, earache, and infection) are all very important factors.
▍Vestibular peripheral vertigo usually comes on suddenly and varies in degree.
It can be a complete balance disorder (Ménière’s disease attack), or it can be a slight balance disorder associated with rapid head movement that occurs in normal elderly people.
▍The duration of peripheral vertigo varies:
Short-term attacks such as benign paroxysmal positional vertigo usually last for a few seconds, while Meniere’s disease lasts for a few minutes or hours. For the elderly, vertigo caused by vascular damage or inflammation of the inner ear can last for several days.
The degree of the latter gradually decreases with the disappearance of the intensifying factors.In more severe cases, it is often accompanied by dizziness, fatigue and general weakness, and these symptoms can be gradually reduced.
If the peripheral vestibule is severely damaged, recovery may take several days to one week.Even in this case, it is necessary to distinguish between spontaneous vertigo caused by Meniere’s disease and short-term vertigo caused by damage or loss of vestibular receptor function.
Peripheral vertigo, even if the damage is very serious, will surely recover gradually with the occurrence of central compensation, although the duration of symptoms may vary depending on the degree of damage.
Vertigo that lasts for a long time without fluctuating changes is generally not caused by peripheral causes.
The frequency of vertigo attacks can also provide meaningful information for determining the cause.
Recurrent vertigo related to specific head movement or position often indicates BPPV.The onset lasts for a few days and is accompanied by severe other symptoms suggesting permanent or repeated damage to the inner ear.Vertigo that occurs intermittently and lasts for several minutes or hours may be Meniere’s disease.
Factors related to vertigo can help diagnose specific disease processes.
The appearance or aggravation of fluctuating hearing loss, earache and tinnitus are typical manifestations of Meniere’s disease.
Positional vertigo is often aggravated by the following factors: turning over in bed, sitting up in a supine position, stretching the neck and looking up, or leaning over to straighten up.Meniere patients can be relieved by lying still in bed.Perilymphatic phlegm often has short-term dizziness and can be aggravated by pressure changes in the middle ear, such as coughing, sneezing, sudden changes in height, or vigorous physical activity.Occasionally, when perilymphatic sputum or inner ear disease (syphilis, advanced Meniere’s disease), violent sound can also cause dizziness.Inner ear discharge and upper respiratory tract symptoms are very important for the diagnosis of labyrinthitis.
The history of taking alcohol, sedatives, anticonvulsants or barbiturates are also important factors influencing dizziness.
Cardiovascular diseases, metabolic disorders or allergic conditions, decreased vision or general neurological disorders are also related to vertigo.Dizziness and severe headaches often indicate migraine syndrome, and family members often have similar medical history.If the headache is accompanied by ataxia, you should ask whether other members of the family have similar symptoms.
Vertigo can occur naturally when the blood supply to the brain is insufficient, such as changes in the body or head position in the case of hypotension or cardiac insufficiency, or transient cerebral ischemia in the case of insufficient blood supply to the vertebrobasilar artery.
The latter situation must be distinguished from the Tumarkin episode of Meniere’s disease.Patients with cerebral blood supply disorders usually feel general weakness, especially lower limbs, transient neurological symptoms, diplopia, transient amaurosis, dysphonia, transient disorientation, and finally close or complete loss of consciousness.
Patients with a Tumarkin attack will feel thrown to the ground without unconsciousness.Both of these conditions occur in elderly people with Meniere’s disease.
Constant and stable dizziness without vertigo attacks is generally the central cause, and other central symptoms or signs should be further asked (such as brain nerve function evaluation and brain imaging examination).
Excerpt from Herdman (U.S.) “Vestibular Rehabilitation-Diagnosis and Treatment of Vestibular System Diseases (2nd Edition)”
Translation: Peng Huihuan made in China
Audit: Made in China