As a doctor who often gropes in the emergency department, dizziness is definitely an inextricable topic. About half of the patients admitted came to see a doctor because of dizziness.
There is a joke circulating among doctors: dizzy patients see too much, and doctors are dizzy. The patient with headache sees too much, the doctor also has headache. Why?
On the one hand, dizziness is a very common symptom: about 1.8% of young people will experience dizziness and about 30% of the elderly will experience dizziness. I believe you have also heard people around you say dizziness symptoms.
On the other hand, Although they are all called dizziness, But the symptoms are diverse, There are mainly the following categories: vertigo (vertigo), pre-syncope state (dizziness, weakness, presyncope, fault), balance disorder (unstable standing or walking), ill-defined light-headedness (often related to anxiety) that is difficult to clearly describe, and even sometimes patients use dizziness to refer to blurred vision and epileptic seizures. Therefore, in the face of dizziness symptoms, we should first distinguish which category it is and then further clarify the diagnosis.
Vertigo is the most common symptom of dizziness. A German survey shows that about 7.8% of people will experience vertigo at least once in their lives.
Is vertigo what’s feeling?
Vertigo is a subjective symptom. Patients feel that they or their surroundings rotate, float, shake or roll, etc. It is a motor illusion or motor illusion.
But in practice, There are many forms of expression. The most classic conscious spin, also known as visual rotation, sometimes feels like a boat bumping up and down, or involuntarily shaking back and forth, sometimes feels involuntarily deflected to one side when standing or walking, and sometimes feels that one has a tendency to move in a certain direction when lying in bed.
Even sometimes it is only manifested as vertigo attack, the patient is only willing to lie on the bed with his eyes closed and motionless, and when he moves, he becomes dizzy.
What is vertigo?
The human body obtains the necessary information through several sensory systems to maintain posture and body balance. It is precisely because these systems cooperate seamlessly that we can stand, walk, lie down, sit up and move freely. Once these systems go wrong, the above-mentioned motor illusion (hallucination) will occur.
The information of the three systems comes from vision, positional receptors located in the inner ear, and proprioception from muscle and joint receptors.
Among them, the most important is the position sensor located in the inner ear, which transmits the position sense to the brainstem through the vestibular nerve and further to the cerebral cortex and cerebellum. Therefore, problems with the position sensor of the inner ear, vestibular nerve, brainstem, cerebellum and the cerebral cortex responsible for the position sense may cause vertigo symptoms.
The common diseases that affect these places and cause vertigo are as follows: Benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, phobic postural vertigo, basilar artery migraine, Vertigo symptoms may also occur when transient ischemic attack, cerebral infarction and cerebral hemorrhage involve brain stem and cerebellum related tissues, but it is often accompanied by other nerve nuclei or fiber involvement such as limb numbness, weakness and angle of mouth deviation.
Patients with vertigo as the only manifestation have a 2.7% probability of transient ischemic attack or cerebral infarction, which is a very rare case.
Therefore, only a small part of the patients suffer from cerebrovascular diseases when they have simple vertigo symptoms and no obvious nerve involvement such as limb numbness, weakness, unfavorable movement, facial numbness, or skewed mouth angle and double vision.
Otolith, is it what?
There are so many diseases that cause vertigo, this time we will only introduce the most common one: benign paroxysmal positional vertigo. This is the largest gang in vertigo Jianghu.
17 ~ 42% of vertigo patients are caused by benign paroxysmal positional vertigo. Sometimes there is a clear cause, such as head trauma, and sometimes no clear cause can be found. Is this name so long a bit around? It also has a popular name: otolith.
In addition to listening to sound, the innermost snail-like thing in the ear is the cochlea, which is responsible for sensing sound. The snail’s tail is responsible for sensing balance, especially the semicircular canal, which is the semicircular canal, which is three consecutive semicircular organs.
Calcium carbonate particles on the elliptical sac near it fall off and fall into these curved tubes (semicircular canals), causing vertigo when the head position changes, so it is called otolith.
In particular, the posterior semicircular canal is the lowest in that position. Its lower outlet is blocked by ampullary crest. Otolith is not easy to slide out of the upper outlet under the action of gravity. It oscillates repeatedly with the movement of the head in this tube, causing vertigo. Due to the particularity of its structure, about 90% of otolith is caused by posterior semicircular canal lesions.
The typical clinical manifestation of otolith is vertigo with head position change. But the head position remains stationary, Vertigo symptoms can quickly disappear, Generally, it takes less than 1 minute and can be accompanied by nausea and vomiting symptoms and nystagmus signs (if you carefully observe the patient’s eyes during vertigo, you can see the involuntary oscillation of the eyeball back and forth). The two accompanying symptoms and signs are caused by the nerve fiber connection between the nucleus responsible for position perception and the nucleus responsible for gastrointestinal movement and eyeball movement.
For example, some typical patients wake up, As soon as I get up, Suddenly I felt the sky whirling, With nausea, vomiting, Lay down quickly, Stay still. After a while, the vertigo will pass, Just breathed a sigh of relief, Turn over, The result was another spin of the sky, Slowly, Find out the rules, If you do not move in one direction, you will not suffer from vertigo. If you move in another direction, you will suffer from severe vertigo. The direction of vertigo is related to which semicircular canal is affected. Doctors can use induction tests to check which semicircular canal is wrong. This induction test is called Dix-Hallpike test.
Therefore, if the doctor needs to do a few actions, causing the patient to calm down and become nauseous and vomiting, the doctor will calmly tell the patient and his family members that there is no great danger and the family members should not be angry.
This is because, first, it can make a clear diagnosis, which is helpful for the next correct treatment, avoiding detours and using unnecessary drugs. Second, although this kind of vertigo is painful, most of them are not seriously affected. If you persist, a minute or two will pass.
It can also be seen from the name of its disease that it is benign, which is very critical, indicating that it is the first to be safe and rarely leads to serious consequences. Third, even if you don’t do any treatment or take any medicine, you will get better slowly in a few weeks to months. However, if you do otolith reduction treatment in the hospital, it will help you recover faster and suffer less vertigo.
If you can gain a little from this article, I will be satisfied. I hope to increase everyone’s understanding of vertigo.