Dizziness

Dizziness is a sensation of imaginary movement of one's own body or surrounding objects.

In practice, the term “dizziness” is interpreted much more broadly and includes sensations and conditions caused by disturbances in the receipt of sensory information (vestibular, visual, proprioceptive, etc.), its processing, and manifested by difficulties in spatial orientation.

Dizziness is one of the most common reasons for seeking medical help. In outpatient settings, 2-5% of patients complain of dizziness. The frequency of complaints of dizziness increases with age and reaches 30% or more in people over 65 years of age. According to Lopez-Gentili et al. (2003), of 1,300 patients who sought medical help for vestibular disorders, 896 (68.9%) had systemic dizziness, while the rest had non-systemic dizziness associated with psychogenic disorders and, less frequently, with syncopal states. In more than half of patients with systemic dizziness, it was positional in nature, and in a third of cases it tended to recur.

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Causes of dizziness

The mechanism for ensuring the maintenance of balance is one of the most ancient acquired by humans in the process of evolution. Balance is achieved by integrating the activity of the vestibular, visual, proprioceptive and tactile sensory systems, close connections with other structures of the brain, in particular, the subcortical formations and the cerebral cortex.

The vestibular analyzer has a very complex neurochemical organization. The leading role in the transmission of information from the receptors of the semicircular canals is played by histamine, which acts on histamine H1- _and H3 _- receptors (but not H2 _- receptors, mainly located in the mucous membrane of the gastrointestinal tract). Cholinergic transmission has a modulating effect on histaminergic neurotransmission. Acetylcholine ensures the transmission of information from receptors to the lateral vestibular nuclei, as well as to the central parts of the analyzer. Existing experimental data suggest that vestibulovegetative reflexes are realized due to the interaction of the cholinergic and histaminergic systems. Vestibular afferentation to the medial vestibular nucleus is provided by both histaminergic and glutamatergic pathways. In addition, GABA, dopamine, serotonin, and some neuropeptides play an important role in the modulation of ascending impulses.

The mechanisms of dizziness development are extremely diverse, which is due to the possibility of damage to various parts of the nervous system in general and the vestibular analyzer in particular. The main cause of systemic dizziness is damage to the peripheral part of the vestibular analyzer (semicircular canals, vestibular nerve, vestibular ganglia) due to degenerative, toxic, traumatic processes. Relatively rarely, the leading mechanism of dizziness development is acute ischemia of these formations. Damage to higher structures (brain stem, subcortical structures, white matter and cerebral cortex) is usually associated with vascular pathology (arterial hypertension, atherosclerosis), traumatic, degenerative diseases (parkinsonism, multisystem degeneration, etc.).

The causes of dizziness are varied: Meniere's disease, vestibular neuronitis, benign postural vertigo, vertebrobasilar ischemia, the influence of ototoxic drugs, labyrinthitis, destructive lesions of the middle ear (cholesteatoma), acoustic neuroma, herpes infection, obstruction of the Eustachian tube, syphilis.

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Benign positional vertigo

It is provoked by head movement (often when the patient turns his head while lying in bed) and lasts for several seconds. This condition is often observed after a head injury, which may be due to damage to the elliptical saccule ("utricle") in the vestibular apparatus. Provocative test: seat the patient on a couch, ask him to turn his head to the side towards the doctor. While maintaining this head position, quickly lay the patient on his back, with the head held 30 ° below the level of the couch and remain in this position for 30 s. Nystagmus in benign positional vertigo is circular in nature, and its movements "beat" in the direction of the ear on which the patient's head is lying. Nystagmus begins after a latent period lasting for several seconds and stops after 5-20 s; nystagmus becomes weaker when the test is repeated, but is accompanied by vertigo. If any of the signs are missing, look for the central cause of dizziness. This disease is self-limiting.

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Vestibular neuronitis

The disease occurs after a febrile condition in adults, usually in winter, and is probably associated with a viral infection. In such cases, sudden vertigo, vomiting, and prostration are caused by head movement. Treatment is symptomatic (eg, cyclizine 50 mg every 8 hours). Recovery occurs in 2-3 weeks. The disease is difficult to differentiate from viral labyrinthitis.

Meniere's disease

The disease is based on the expansion of the endolymphatic spaces of the membranous labyrinth, which leads to paroxysms of vertigo lasting up to 12 hours with prostration, nausea and vomiting. Attacks of the disease tend to occur in "clusters" with complete remission between them. There may be tinnitus and progressive sensorineural deafness. An acute attack of vertigo in such cases is stopped symptomatically (cyclizine 50 mg every 8 hours). Betahistine 8-16 mg every 8 hours orally gives less predictable results, but it should also be tried to prescribe it to the patient. Surgical decompression of the endolymphatic sac can relieve vertigo, prevent progression of the disease and preserve the ability to hear. Labyrinthectomy relieves vertigo, but causes complete bilateral deafness.

What causes dizziness?

Pathogenesis

The pathogenesis of dizziness can be caused by different factors and depends on the specific cause of this symptom. Dizziness is often associated with a disturbance of balance and coordination of movements, as well as with a disturbance of the functions of the vestibular system of the inner ear and central structures in the brain. Here are some of the possible mechanisms of dizziness pathogenesis:

1. Vestibular disorders: Dizziness can be caused by disorders of the vestibular system, which is responsible for controlling balance and coordination of movements. These disorders can be caused by inner ear problems such as Mennier's disease, vestibular neuritis, or labyrinthitis, as well as other factors.
2. Central nervous system disorders: Dizziness can be a consequence of disorders in the central structures of the brain that control balance and coordination of movements. These can be diseases such as Parkinson's disease, migraine, strokes, brain tumors and other pathologies.
3. Low Blood Pressure: Very low blood pressure (hypotension) can cause a lack of blood supply to the brain, which in turn can lead to dizziness.
4. Stress and anxiety: Psychological factors such as stress, anxiety and panic attacks can cause physiological reactions including dizziness.
5. Medicines and drugs: Some medications, particularly blood pressure medications, antidepressants, antihistamines, and others, may have dizziness as a side effect.
6. Infections and inflammation: Infections of the inner ear, brain, or other infections can cause inflammation and changes in the function of the vestibular system, leading to dizziness.

7. Vascular disorders: Various vascular disorders such as vascular dystonia or vascular pain can affect the blood supply to the brain and cause dizziness.

Understanding the pathogenesis of dizziness is important for proper diagnosis and treatment. To accurately determine the cause of dizziness and develop appropriate treatment, it is recommended to consult a doctor or neurologist for the necessary examinations and diagnosis.

Classification of dizziness

A distinction is made between systemic (vestibular) and non-systemic dizziness; the latter includes imbalance, pre-syncope conditions, and psychogenic dizziness. In some cases, the term "physiological dizziness" is justified.

Systemic dizziness is pathogenetically associated with direct damage to the vestibular analyzer. Depending on the level of its damage or irritation, peripheral and central systemic dizziness are distinguished. In the first case, the disease is caused by damage directly to the semicircular canals, vestibular ganglia or nerves, in the second - to the vestibular nuclei of the brainstem, cerebellum or their connections with other structures of the central nervous system. Within the framework of the systemic, it is possible to distinguish proprioceptive dizziness (a feeling of passive movement of one's own body in space), tactile, or tactile (a feeling of movement of support under the feet or hands, rocking on waves, falling or lifting the body, swinging back and forth, right and left, up and down, unsteadiness of the soil - "walking as if on bumps") and visual (a feeling of progressive movement of objects in the visible environment).

Non-systemic dizziness:

• Disturbances of balance are characterized by a feeling of instability, difficulty in walking or maintaining a certain posture, possibly increasing unpleasant sensations when performing actions that require precise coordination of movements. Disturbances of balance are based on a misalignment of the activity of the vestibular, visual and proprioceptive sensory systems, which occurs at various levels of the nervous system.
• The pre-fainting state is characterized by a feeling of nausea, the proximity of loss of consciousness, and the true sensation of rotation of the patient himself or the world around him is absent.
• Psychogenic dizziness is observed in the context of anxiety and depressive disorders.

Physiological dizziness occurs when the vestibular system is overstimulated. It is observed in the case of a sharp change in speed of movement (motion sickness), during prolonged rotation, observing moving objects, being in a state of weightlessness, etc. It is included in the motion sickness syndrome (seasickness, kinetosis).

In a number of patients, a combination of manifestations of both systemic and non-systemic dizziness with varying severity of accompanying emotional and autonomic disorders is observed.

With non-systemic dizziness, unlike systemic dizziness, there is no sensation of movement of the body or objects. Systemic dizziness (vertigo) can be of peripheral (vestibular) or central origin (the VIII pair of cranial nerves or the brainstem, its vestibular nuclei, the medial medulla oblongata, the cerebellum, the vestibulospinal tract). Vertigo of vestibular origin is often very sharp. It can be accompanied by nausea and vomiting, hearing loss or tinnitus, and nystagmus (usually horizontal). With vertigo of central origin, which usually manifests itself less sharply, hearing loss and tinnitus are observed less often. Nystagmus can be horizontal or vertical.

Symptoms of dizziness

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Examination of a patient with dizziness

The head and neck should be carefully examined and the condition of the cranial nerves should be checked. It is necessary to perform tests for the preservation of cerebellar function, check tendon reflexes, perform the Romberg test (positive if balance worsens with the eyes closed, which may indicate pathological positional sense in the joints, originating from the joints or associated with vestibular disorders). It is necessary to check for nystagmus.

Diagnosis of dizziness

Tests

These include audiometry, electronystagmography, brainstem auditory evoked responses (potentials), calorimetric testing, CT scanning, electroencephalography, and lumbar puncture.

Differential diagnostics

Differential diagnosis of dizziness is the process of identifying and distinguishing between the various possible causes of dizziness based on clinical symptoms, history, and examination findings. Because dizziness can be caused by many different factors, it is important to conduct a thorough examination to identify the underlying cause of the symptom. Some of the most common conditions to consider in the differential diagnosis of dizziness include:

1. Vestibular disorders:

   • Mennier's disease
   • Vestibular neuritis
   • Labyrinthitis
   • Paroxysmal positional vertigo (Benigne paroxysmal positional vertigo, BPPV)

2. Vascular disorders:

   • Hypotension (low blood pressure)
   • Orthostatic hypotension
   • Migraine
   • Hypertension (high blood pressure)
   • Vascular dystonia

3. Neurological disorders:

   • Stroke
   • Parkinson's disease
   • Epilepsy
   • Brain tumors
   • Dementia

4. Psychological and psychiatric reasons:

   • Anxiety disorders
   • Panic attacks
   • Depression

5. Infections:

   • Intra-ear infections
   • Acute respiratory viral infections

6. Medications: Dizziness can be a side effect of certain medications, such as antihistamines, antidepressants, and others.

7. Injuries and trauma: Dizziness can result from a head or neck injury.

8. Anemia: Lack of oxygen in the blood caused by anemia can lead to dizziness.

To establish an accurate diagnosis and choose the best treatment method, it is important to conduct a comprehensive examination of the patient, including physical and neurological examination, as well as additional methods such as magnetic resonance angiography (MRA), magnetic resonance spectroscopy (MRS), electroencephalogram (EEG), CT scanning and others. Treatment of dizziness depends on its cause and may include drug therapy, physical rehabilitation, psychotherapy, surgery or lifestyle modification. The need for differential diagnosis and the choice of treatment methods are determined by the doctor based on the results of the examination and clinical analysis.

What to do if you feel dizzy?

Dizziness can be caused by various reasons, and the treatment or steps to take depend on the source of the problem. If you are experiencing dizziness, it is recommended that you follow these steps:

1. Sit or lie down: If you feel dizzy, try sitting or lying down. This can help prevent falls and injuries.
2. Support yourself: If you're sitting, hold on to something to help you maintain your balance. If you're lying down, try tilting your head to the side to help reduce dizziness.
3. Breathe deeply: Taking full, slow breaths can help calm your nervous system and improve your sense of well-being. Try inhaling slowly through your nose and exhaling slowly through your mouth.
4. Make sure you are safe: If you become dizzy in a dangerous situation, such as while driving, stop immediately and give yourself time to regain your balance.
5. Drink water: Dehydration can be one of the causes of dizziness. Make sure you drink enough water, especially in hot weather or when exercising.
6. Avoid sudden movements: Try to avoid sudden turns of the head or body, which may increase the dizziness.
7. Get Medical Help: If dizziness does not go away or is accompanied by other serious symptoms such as numbness, weakness, difficulty breathing, severe headache, or if you have a serious medical problem, seek medical attention immediately or call 911. Dizziness can be caused by a variety of medical conditions, such as low blood pressure, vestibular disorders, infections, or other conditions.

Don't ignore dizziness, especially if it's recurring or accompanied by other strange symptoms. Consulting with a doctor can help determine the cause and develop a treatment plan or recommendations to address the problem.

Treatment of dizziness

Treatment depends on the cause. Because dizziness can be a symptom of a variety of diseases and conditions, it is important to identify the underlying disorder and target treatment to address it. Here are some common approaches to treating dizziness:

1. Treating the Underlying Condition: If your dizziness is caused by a medical disorder, such as vestibular neuritis, Meniere's disease, migraine, or other conditions, it is important to treat that condition. Treatment may include medications, physical therapy, or surgery, depending on the individual case.
2. Blood pressure management: If hypotension or hypertension is the cause of dizziness, then controlling blood pressure can help relieve symptoms. This may include lifestyle changes and medications under the supervision of a doctor.
3. Migraine prevention: If migraines cause dizziness, your doctor may prescribe medications or recommend lifestyle changes to prevent migraines.
4. Physical therapy and rehabilitation: For some types of dizziness, physical therapy can help restore balance and relieve symptoms.
5. Stress and Anxiety Management: For dizziness caused by stress and anxiety, relaxation techniques, meditation, and psychotherapy may be helpful.
6. Eliminating external factors: If dizziness is caused by sensory factors such as driving a car or boat, drinking alcohol or taking medications, it is important to avoid these factors or take appropriate precautions.
7. Lifestyle changes: Sometimes lifestyle changes, such as eating right, exercising regularly, and getting enough sleep, can help reduce dizziness.

It is important to consult a doctor to determine the cause and treatment of dizziness, as the correct treatment depends on the diagnosis. Self-medication is not recommended, especially if dizziness becomes chronic or is accompanied by other serious symptoms.

Medicines for dizziness

Treatment for dizziness depends on its cause. Since dizziness can be caused by many different factors, your doctor must determine the underlying cause and prescribe appropriate treatment. In some cases, the following groups of medications may be used to relieve symptoms of dizziness or treat its cause:

1. Antidepressants and anxiolytics: If your dizziness is related to anxiety or panic attacks, your doctor may prescribe antidepressants (such as selective serotonin reuptake inhibitors, like sertraline) or anxiolytics (anti-anxiety drugs) to reduce symptoms and stress.
2. Antihistamines: These medications can help with vertigo associated with vestibular disorders. Examples include mecizine (Antivert), cinnarizine (Stugeron), and others.
3. Medications to treat Mennier's disease: If Mennier's disease is the cause of your dizziness, your doctor may prescribe diuretics (such as furosemide) or antiemetics (such as meclizine) to control symptoms.
4. Migraine medications: For migraines that include dizziness, your doctor may prescribe specific migraine medications, such as triptans (eg, sumatriptan) or migraine preventive medications.
5. Medications to treat vascular disorders: If your dizziness is related to vascular problems, your doctor may prescribe medications to normalize blood pressure or improve blood flow, depending on your specific situation.
6. Other medications: In some cases, your doctor may prescribe medications to treat the underlying condition that is causing your dizziness, such as antibiotics for ear infections or antiepileptic drugs for epilepsy.

It is important to emphasize that self-medication for dizziness with medications without consulting a doctor can be dangerous, as medications can have side effects and interact with other medications you may be taking. If you have dizziness or other bothersome symptoms, see a doctor for diagnosis and the best treatment based on your medical condition and the cause of dizziness.