19Feb

Dizziness - Causes, Diagnosis and Treatment

Mechanism of sensation of body position
Vertigo is one of the most common symptoms, and accounts for approximately 5% of all complaints to physicians of various specialties. The proportion of patients increases with age, and in people over 65 it is approximately 50%.

Dizziness is an illusion of the movement of the environment or your own body, which is often accompanied by nausea or vomiting. Most often, the cause is damage to the vestibular apparatus and / or its nerve connections - then it is called system dizziness .In other cases, the cause is cardiovascular, psychogenic disorders and diseases, trauma and other causes of disruption of the CNS.

Read also :
  • Why dizziness and nausea occur
  • What causes dizziness and loss of balance in adulthood

Contents of

  • 1 1. Causes of dizziness
    • 1.1 Neurological and otolaryngological causes
      • 1.1.1 Reasons associated with the peripheral nervous system:
      • 1.1.2 Reasons associated with the central nervous system:
    • 1.2 Cardiovascular and metabolic causes
    • 1.3 Psychogenic causes of
  • 2 2. Neurological symptoms, withdizziness
    • 2.1 Systemic dizziness
    • 2.2 Inconsistent dizziness
  • 3 3. When it is time to go to the doctor
  • 4 4. Diagnosis of dizziness
    • 4.1 Investigations to identify the causes of dizziness
  • 5 5. Treatment of dizziness
    • 5.1 Medical aids for treating dizziness:
      • 5.1.1 Begastin
      • 5.1.2 Piracetam
    • 5.2 Vestibular Rehabilitation
    • 5.3 Surgical procedure
    • 5.4 Psychological support of

1. The reason

us vertigo Vertigo can cause very different reasons. In young people, most often, this is too much a dose of alcohol or a sudden change in body position. At an older age, this problem can have much more serious reasons. This is why older people should not neglect such a symptom, especially if it is accompanied by others. In such situations, you should not hesitate, but visit a specialist.

Causes can be divided into the following groups:

  • neurological;
  • otolaryngological( ENT);
  • cardiovascular;
  • metabolic;
  • psychogenic( mental, psychological or emotional);

Neurological and otolaryngological causes of

These include dizziness caused by damage to the vestibular apparatus in the inner ear, nerve fibers that conduct a signal from it to the brain, vestibular nuclei in the brainstem or other structures of the nervous system responsible for maintaining equilibrium.

An important point is that only one-sided damage gives a symptom of dizziness, and if both sides fail, this does not happen.

Neurological and otolaryngological causes, which are closely related, can be divided into peripheral and central, based on the location of the "guilty" organs.

Reasons associated with the peripheral nervous system:

  1. Internal ear trauma, for example, fracture of the temporal bone pyramid, perilymphatic fistula formation, concussion.
  2. Inflammation of the inner ear and vestibular apparatus - this ailment can be the result of complications after the flu. Dizziness, nausea and vomiting persist for several days. Treatment is usually done with antibiotics and steroids. It happens that a person is then sent to a special rehabilitation, where he is taught to keep his balance.
  3. Vestibular neuritis is an inflammation of the vestibular part of the vestibulocchlear nerve, most often caused by the virus, less often, by autoimmune or vascular diseases. Symptoms grow for several hours and include systemic dizziness with nausea, vomiting and imbalance. After 2-3 weeks, the symptoms subsided. Tumors in the inner ear.
  4. Ischemia of the inner ear - decreased blood supply, resulting in a temporary disruption of its work or tissue damage.
  5. Meniere's disease - fluid accumulates in the inner ear, which irritates the vestibular apparatus, and there are unexpected attacks of dizziness, nausea and nystagmus( involuntary eye movements).These symptoms are accompanied by a feeling of fullness in the ear, ringing in the ears and hearing loss. Symptoms last from a few minutes to several days, intensify when the head moves and decreases with closed eyes. In the period between bouts may persist during ringing in the ears. In the course of the disease, damage to the hearing occurs. Meniere's disease is treated with diuretics, antihistamines and steroid drugs. Sometimes you can not do without an operation.
  6. Otosclerosis is the growth of the bone in the middle ear, which can affect the inner ear. Dizziness in this case is not always observed, but short-term attacks that occur more often when moving head.
  7. Marine disease.

Causes associated with the central nervous system:

  1. Stroke of the brainstem and cerebellum.
  2. Tumors, vestibular schwannomas( benign formations).
  3. Multiple sclerosis, demyelination( damage to the myelin sheath) when it affects the pre-cochlear nerve.
  4. Migraine.
  5. Epilepsy.
  6. Vertebro-basilar insufficiency is a violation of the blood supply to the brain, which affects the vestibular apparatus.
  7. Inflammation of meninges and brain.
    Dizziness can also occur with a number of other diseases.

Cardiovascular and metabolic causes of

Among cardiovascular and metabolic diseases and disorders that can cause dizziness, it can be noted:

  • reflex syncope( with changes in body position, coughing, emotional changes);
  • disorders of consciousness associated with cardiac arrhythmia, heart defects, cardiomyopathy;
  • hypovolemia( decrease in blood in the body), caused by blood loss, dehydration or anemia;
  • violations of blood pressure regulation;
  • diabetes;
  • kidney failure;
  • thyroid gland hypofunction;
  • menopause;
  • hyperventilation - too intense breathing
  • neurotic disorders - mental disorders.

It is also worth mentioning, the so-called, presyncopal state. It is accompanied by dizziness, darkening in the eyes, weakness in the legs, ringing in the ears, narrowing of the field of vision, pallor, nausea, sweating, but the person is conscious. It occurs in connection with the appearance of orthostatic hypotension - a sudden decrease in blood pressure, especially with a sudden change in the position of the body( the transition from a lying position to a sitting or standing position).This condition usually lasts not for long, the pressure quickly levels out, taking into account the new position of the body. Nevertheless, in some people, especially in old age, dizziness in the presyncopal state can be very severe and persist for several minutes. This condition can also be a consequence of changes in the cardiovascular system caused by atherosclerosis, coronary heart disease, arrhythmia( cardiac rhythm disturbance).Regardless of the cause, the result is too small a cerebral blood flow, which leads to non-systemic dizziness and a pre-stupor, or even a loss of consciousness.

No less important, and besides very common, especially in the elderly, the cause of syncope is anemia. A reduced amount of hemoglobin in the erythrocytes causes insufficient supply of cells with oxygen. Although the main symptom of anemia is fatigue, but because of the lack of oxygen supplied to the brain, dizziness or a pre-patch condition may also occur.

Psychogenic causes of

The most common are neurotic disorders that are associated primarily with the work of surrounding and omnipresent external factors: stress, fear of losing consciousness, suffocation, symptoms of heart rhythm disorders such as palpitations, neurological disorders in the form of tingling, weakness of the hands,mouth or nose. A sense of false movement can very rarely join. Symptoms usually occur throughout the day. Usually accompanied by rapid and deep breathing( hyperventilation), which additionally increases the attack.

With such psychogenic problems with such symptoms, domestic neuropathologists often put such a diagnosis as vegetative vascular dystonia( VSD).But this is a very general concept and is a complex of symptoms. And, according to some experts, this diagnosis is made when they can not reliably establish the cause of

2. Neurological symptoms associated with dizziness

System dizziness

When the cause lies in the vestibular apparatus or the connecting nerves between it and the brain, this dizziness is called systemic or by the vestibular .It usually manifests itself in the form of periodic attacks - it is paroxysmal.

Often a sense of anxiety is attached to the symptoms. A person can feel normal, and suddenly there is a sudden dizziness that lasts from a few seconds to several hours, and in some cases disappears in more than a week. Movement of the head clearly strengthens the symptoms, and the closing of their eyes weaken. Accordingly, when dizziness is caused by problems with the central nervous system( brain and spinal cord), it is defined as non-systemic. People suffering from this problem have a visually difficult feeling of insecurity, unstable posture or gait. They have a sense of instability, movement of the ground underfoot and a deteriorated orientation in space. These symptoms tend to develop slowly. Their duration varies greatly, from a few seconds to several months or years. Characteristic is still the appearance of ophthalmological symptoms, such as( blind spot in the field of vision), double vision, blurred vision, nystagmus, sometimes loss of vision in one eye. These symptoms can be accompanied by a headache. Some dizziness may be accompanied by paresis( partial paralysis) of the cranial nerves, ataxia( impaired movement), dysarthria( speech and / or her understanding), other combinations of neurological diseases such as. Horner's syndrome( lowering of the upper eyelid, narrowing of the pupil, collapse of the eyeball).

3. When it's time to see a doctor

Specialist help is necessary if there are:

  • recurring and severe dizziness, combined with headache;
  • loss of consciousness;
  • muscle weakness in the legs or numbness and tingling in the limbs;
  • difficulties when walking, talking or blurred vision;
  • chest pain accompanied by dizziness;
  • arrhythmia( irregular heartbeat, too slow or fast);
  • before this was a head injury;
  • high temperature( over 38,5 С);
  • rigidity of the occipital muscles( their constant tension);
  • intermittent hearing or vision impairment.

4. Diagnosis of dizziness

During the interview, when the patient complains of dizziness, the doctor is most important to know:

  • symptoms appear suddenly or chronically;
  • that this is facilitated, for example, by changing the position of the body;
  • duration of symptoms and sensations while doing this( circling, build-up, etc.);
  • Predisposing factors: ear infections, hypertension, heart disease, cardiovascular, diseases, eyes, blood, medications taken;
  • Presence of accompanying symptoms, such as hearing loss, impaired vision, speech, swallowing, signs of damage to the cranial nerves, paralysis of the extremities.

It is not always the case that a specialist( otolaryngologist, ophthalmologist or neurologist) can immediately diagnose. Sometimes, in addition to a detailed survey, which takes into account even the housing conditions and place of work, it is necessary to conduct additional research.

Investigations to identify the causes of dizziness

  1. Provocation test - used to determine if peripheral organs( the vestibular apparatus and nerves) are guilty and from which side. They can be made using the Dix-Hallpike method. The patient, sitting on the couch, tilts his head to the side, and then also sharply rolls it back, moving it to a reclining position so that the head begins to droop 30 °.At the same time observe the manifestation of nystagmus and ask about dizziness. Or, in such a reclining position, the vestibular apparatus is irritated with the help of warm air to cause nystagmus. For a better evaluation, Frenzel's glasses are worn on the patient, in which there are magnifying glasses and it is better to see the fluctuations in the eyes.
  2. Audiometric test is a test of hearing. During the test, the patient remains in an anechoic chamber with dressed headphones, in which the sounds of different frequencies are reproduced. When he could hear, he pressed the button.
  3. ENG and VNG, i.e.electro- and video-histogramography - the study of nystagmus( involuntary eye movements), using electrodes attached to the patient's temples, or special glasses with motion sensors.

Other studies used to identify the causes of dizziness include computerized tomography, magnetic resonance imaging, X-rays of temporal bones and cervical spine. EKG, dopplerometry( determining the blood flow velocity in a certain place), or a method of evoked potentials( checking the electrical response of the brain to external stimuli) can also be prescribed.

5. Treatment of dizziness

Treatment of dizziness is based, first of all, on the search for a cause. Part of it is aimed at eliminating the very feeling of dizziness and symptoms from other organs, incl.feeling of anxiety.

Medical aids for the treatment of vertigo:

  • Neuroleptics: chlorpromazine, promazine, thiethylperazine, promethazine;
  • antihistamines: dimenhydrinate, clemastine;
  • preparations acting on the vascular system: betagistin, cinnarizine, flunarizine, polfilin, nicergoline;
  • nootropic( acting on the brain) drugs, for example, piracetam.

Begastin

A common drug in the treatment of vertigo is beta-histidine. Indication for its use is Meniere's disease, which is characterized by the following symptoms: dizziness( nausea, vomiting), progressive hearing loss, tinnitus.

The mechanism of action of betagistin is only partially known. In biochemical studies, it has been established that in the central nervous system, beta-histidine exerts a weak stimulating effect on the H1 receptor and a strong inhibitory effect on the H3 receptor. These are two of the three forms of the receptor of the githamine - the substance produced in the body, which plays an important role in the functioning of the central nervous system. The drug should be used with caution in patients with bronchial asthma, a stomach ulcer or duodenal ulcer. The drug is not recommended for children under 18 due to lack of safety and efficacy data in this group of patients.

Among the common side effects of nausea and indigestion, headaches( headache in patients treated with placebo were as common as those taking beta-histidine).In some patients, there are light gastrointestinal problems, for example, vomiting, pain and bloating, and gas. These symptoms usually decrease when taken with a meal or a reduced dose. Also, allergic reactions are possible - edema, rash, itching, hives and anaphylaxis.

Piracetam

Another frequently prescribed drug is piracetam. It refers to nootropic drugs acting on the central nervous system. Under their influence, cognitive processes improve, thereby improving perception, memory, concentration of attention and awareness. The drug has no soothing and mentally stimulating effect.

Piracetam increases the flow of blood through the vessels to the brain, affecting red blood cells, platelets and the vascular wall: increases the elasticity of red blood cells, reduces the formation of platelets and reduces the likelihood of spasms of cerebral vessels. The drug is administered intravenously or intramuscularly.

Side effects may occur during application. These include disorders of the nervous system, such as ataxia( impaired coordination of movements), imbalance, exacerbation of epilepsy symptoms, drowsiness, insomnia, a sense of fatigue, headaches;disorders of the digestive tract( vomiting, diarrhea, abdominal pain, pain in the upper abdomen).From the side of the immune system, hypersensitivity reactions are possible: agitation, anxiety, confusion, swelling of the Quincke, dermatitis, itching, urticaria. If you have such problems, tell your doctor.

Vestibular rehabilitation

In the defeat of the oporno-motor and vestibular apparatus, which are accompanied by mild dizziness, vestibular rehabilitation can be effective. This training is supported by balance, which allows you to compensate for dizziness. It is also prescribed to people after neurosurgical operations( nevrectomy, labyrinthectomy) after traumatic brain injury in patients with anxiety neuroses, Meniere's disease( when seizures occur less than once a month), CNS and mixed lesions. This procedure is not suitable for people who are dizzy and disequilibrium appear periodically in the form of seizures.

Surgical operation

Surgical treatment is used in some cases when certain causes of dizziness are known, for example, a tumor or otosclerosis. Also, surgery is prescribed, when there is not enough improvement after conservative treatment with Meniere's disease - the symptoms still continue to be observed. To this type of operations are:

  • intersection of the vestibular nerve;
  • removal of otoliths( "grains", annoying channels) that cause benign paroxysmal positional vertigo;
  • removal of organs of the inner ear( labyrinthectomy), in case of deep hearing loss.

Psychological support of

On the part of doctors, an important component of treatment is also psychological support and a calm detailed explanation of the nature of the disease and symptoms. And in the case of depression or neurotic disorders - adding to the therapy of antidepressants or tranquilizers, consultation with a neurologist or psychiatrist.