How much do you know about vertigo: take you to understand the common causes of vertigo

  Most of us have probably experienced vertigo, mild or severe, at some point. When you feel dizzy and dizzy, or have symptoms such as unsteady walking, dizzy mind, etc., many people think that it is caused by insufficient blood supply to the brain or cervical spondylosis, so they panic. Vertigo bothers us and affects our life and work. However, there are many causes of vertigo, and different reasons may mean different outcomes. Let’s get out of the misunderstanding and understand the most common causes of vertigo and the most common causes and treatments that need to be identified.
  Vertigo and dizziness are very common clinical symptoms of the nervous system, and vertigo is currently one of the three major symptoms in neurology outpatient clinics. Vertigo attacks not only seriously affect the patient’s life, work, and study, but may also be an early warning of some serious diseases. In addition, for elderly patients, they sometimes fall due to dizziness and unsteady standing, resulting in fractures, trauma, etc., which bring a series of adverse consequences. Therefore, it is necessary to correctly understand and deal with the disease to avoid misdiagnosis.
  Although in the past few decades, when it comes to dizziness, people will think of the two terms of insufficient blood supply to the brain or cervical spondylosis, but in fact dizziness caused by “cervical spondylosis” is rare, and “cerebral blood supply The concept of “insufficient” has long been no longer used clinically. Therefore, it is very important to abandon traditional concepts and correctly understand vertigo.
  1. Otolith disease, also known as “benign paroxysmal positional vertigo”, is one of the most common clinical vertigo diseases, accounting for 20% to 30% of vestibular vertigo. Among them, patients aged 50 to 70 are in the majority, and the incidence rate of women is 2 to 3 times that of men, and the incidence rate gradually increases with age. The main manifestation is a brief episode of vertigo when the head position changes (such as lying down, getting up, turning over while lying down, etc.). The vertigo attack of this disease usually lasts only a few seconds or tens of seconds, and rarely exceeds 1 minute. However, some patients may experience dizziness and unsteady walking for several hours to several days after vertigo. The main treatment method is manual reduction. Depending on the affected part, the reset method is also different, which needs to be decided by a professional physician according to the condition. It is not recommended for patients to reset themselves. In addition, if the patient has severe cervical spondylosis, heart disease, etc., the doctor must be informed in advance before reset. Although manual reduction can make most patients recover, some patients will have some residual symptoms. It can also guide patients to perform vestibular rehabilitation training. Surgical treatment may also be considered for a small number of refractory patients.
  2. Persistent postural-perceptual dizziness (PPPD) may be unfamiliar to everyone, but in fact, there have been many studies on this disease at home and abroad. According to clinical statistics, the incidence of PPPD ranks second among dizziness diseases, second only to otolithiasis. It is more common in female patients, and the average age of seeing a doctor is 40 years old. Another study found that about 1/4 of patients with acute or paroxysmal vestibular disease will develop into PP-PD after follow-up for 3 to 12 months. The disease has three core symptoms, namely dizziness, unsteadiness in standing or walking, and non-rotational vertigo. Patients often tell their doctors that they feel dizzy, fuzzy, or light-headed, that they shake when they walk, and that they feel like they are falling from one side to the other; These symptoms can last for more than 3 months. Symptoms may appear when standing or walking, and are also prone to symptoms in elevators, cars, or in crowded crowds. Before the onset, there may be acute and episodic dizziness events (such as otolithiasis, vestibular migraine, Meniere’s disease), or psychological stress, etc. Treatment requires a “multi-pronged approach”, including psychotherapy, drug therapy (serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, commonly used drugs are sertraline, citalopram, pa Roxetine, etc.). Vestibular rehabilitation and cognitive behavioral therapy are also available. The study found that comprehensive treatment is critical to the recovery of the disease.
  3. Vestibular migraine is a genetic predisposition to recurrent dizziness or vertigo, which may be accompanied by nausea, vomiting and headache. It is one of the common causes of vertigo and ranks third among vertigo-related diseases. However, due to insufficient awareness of doctors and patients in the past, the prevalence rate has been seriously underestimated. Some studies have pointed out that the misdiagnosis rate can reach as high as 80%. The reason why the misdiagnosis rate is high is also related to the changeable manifestations of the disease, which makes it known as “the chameleon in dizziness”. It can be manifested as simultaneous attacks of headache and vertigo. In most patients, headache occurs several years earlier than vertigo, and some migraines are always related to vertigo. A small number of patients have vertigo onset earlier than headache, and very few patients have no headache symptoms throughout the course of repeated vertigo. Fatigue, lack of sleep, tension and some foods (such as red wine, chocolate, etc.) can all induce vestibular migraine. The treatment during the attack period is mainly symptomatic treatment for symptoms such as dizziness and vomiting, and the drugs include triptans (such as zolmitriptan) and vestibular inhibitors (such as promethazine, diphenhydramine); Preventive drug therapy can be chosen, including β-blockers (propranolol, metoprolol), calcium antagonists, antiepileptic drugs (valproic acid, topiramate), etc.
  4. Meniere’s disease is a common otogenic vertigo disease, the main clinical manifestations are paroxysmal vertigo, hearing loss, tinnitus and ear fullness. Vertigo episodes last anywhere from 20 minutes to 12 hours, usually no more than a day. Drug therapy is mainly vestibular inhibitors and glucocorticoids. In addition, the adjustment of living habits, such as limiting the intake of salt, controlling tobacco, alcohol, coffee, etc. is also very important.
  5. Vestibular neuritis is a common peripheral vestibular disease, and its incidence is second only to otolithiasis and Meniere’s disease. The onset is sudden, manifested as acute and persistent vertigo, accompanied by nausea, vomiting and instability, easy to fall to the affected side when standing, without hearing loss, and the vertigo will be aggravated when the head is moved. This severe vertigo can last from days to weeks. Most vestibular neuritis has a monophasic course, and if there is a second attack, the diagnosis of vestibular neuritis is basically not considered. Treatment of vestibular neuritis includes medication, vestibular rehabilitation, and patient education. When obvious nausea, vomiting, and dizziness occur in the acute stage, vestibular inhibitors such as promethazine can be used briefly, generally not exceeding 3 days; long-term use may affect the establishment of the body’s compensatory mechanism. Others such as betahistine can also be considered; the use of glucocorticoids in the acute phase is still controversial. The specific medication regimen needs to be judged by a specialist physician.
  6. Posterior circulation ischemia refers to cerebral infarction or transient ischemic attack in the posterior circulation. Although not a common cause of acute vertigo, it can be life-threatening if not treated promptly. In addition to dizziness, posterior circulation ischemia is often accompanied by some neurological symptoms, such as dysphagia, slurred speech, limb weakness, crooked mouth corners, and double vision. Once these symptoms appear, you need to see a neurologist immediately without delay.
  The above are common diseases that cause vertigo, but it is often found in clinical practice that a patient often does not have a single cause, and it is not surprising that two or even three vertigo diseases appear in the same patient. Therefore, comprehensive consideration of several etiologies is very important, which can better help patients recover.
  Of course, the causes of vertigo are far more than these, and the clinical symptoms are also complex and changeable, and multiple disciplines are often involved in the diagnosis and treatment (including neurology, ENT, psychiatry, etc.). Having said so much, the identification of the cause of vertigo/dizziness is very important. Only when the correct cause is found can we “prescribe the right medicine” and get rid of the trouble of vertigo.

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