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Symptoms of dizziness
Last reviewed: 20.11.2021
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Symptoms of dizziness are largely determined by the level of damage (peripheral or central parts of the vestibular analyzer, other parts of the nervous system) and associated neurologic symptoms associated with it. To establish the localization of the lesion and its nature, a careful analysis of the clinical picture, peculiarities of dizziness, and the recording of accompanying symptoms are necessary. Thus, systemic dizziness, resulting from the lesion of the vestibular analyzer, in 2/3 of the cases may be accompanied by a sensation of noise in the ears and autonomic disorders.
Systemic dizziness
Systemic dizziness is observed in 30-50% of all patients who complain of a feeling of dizziness, and its frequency increases with age. Its causes are diverse, the most frequent of which are Meniere's disease, neurinoma of the VIII pair of cranial nerves, benign paroxysmal positional dizziness, vestibular neuronitis. A correct evaluation of the anamnestic information and the results of the clinical examination make it possible in 90% of cases to make a correct assumption about the nature of the disease after the first examination of the patient.
Benign paroxysmal positional dizziness
Benign paroxysmal positional vertigo (DPPH) is the most common cause of systemic dizziness. In Western Europe, the prevalence of PDPH in the general population reaches 8% and increases with age. At the heart of this disease lies cupulolithiasis - the formation of calcium carbonate aggregates in the cavity of the semicircular canals, which have an irritant effect on the receptors of the vestibular analyzer. It is characterized by brief (up to 1 min) episodes of intense dizziness that occur when the head position changes (moving to the horizontal position, turning in the bed). At the same time, the patient often has nausea and other vegetative disorders (hyperhidrosis, bradycardia). When examined, a horizontal or horizontal rotator nystagmus is identified, the duration of which corresponds to the duration of dizziness. Distinctive features of DPPH are stereotyped seizures, their clear connection with the position of the head, greater severity in the morning hours and a decrease in the second half of the day. An important distinctive feature is the absence of focal neurological deficit, tinnitus and hearing disorders.
Vestibular neuronitis
Vestibular neuronitis is characterized by episodes of acute dizziness lasting from a few hours to a day (sometimes more). The disease arises sharply, much less often - subacute, usually after a viral or bacterial infection, less often - intoxication. People who are 30-35 years old are more likely to get sick. Dizziness intense, with severe autonomic disorders. Characteristic are the preserved hearing, the absence of meningeal and focal neurological symptoms.
Post-traumatic dizziness
Post-traumatic dizziness occurs immediately after a head injury, with meningeal syndrome, as well as focal symptoms of brain and cranial nerve damage, may be absent. This clinical picture suggests an acute traumatic lesion of the maze itself. Significantly less often, dizziness occurs several days after the injury, which may be associated with the formation of serous labyrinthitis. In some patients, the trauma of the head with the lesion of the vestibular apparatus can lead to the development of cupulolithiasis, manifesting itself in the syndrome of DPPH. In many patients, the psychogenic component of dizziness is important.
Toxic lesion of the vestibular apparatus
Toxic lesion of the vestibular apparatus can develop with the use of aminoglycosides, characterized by the ability to accumulate in the endo- and perilymph. It should be noted that if gentamycin more often leads to a lesion of the vestibular apparatus, then aminoglycosides such as tobramycin and kanamycin are more likely to cause hearing damage due to injury to the cochlea. The toxic effects of aminoglycosides lead to the development of progressive systemic dizziness combined with impaired coordination of movements. When prescribing drugs of this group, it should be borne in mind that they are excreted mainly by the kidneys. The ototoxic effect of aminoglycosides, as a rule, is irreversible.
Ménière's disease
Ménière's disease is characterized by repeated attacks of intense system dizziness, noise, ringing in the ears, pronounced autonomic disorders and fluctuating hearing loss. The basis of these manifestations is a hydrops - an increase in the volume of the endolymph, which causes the stretching of the walls of the channels of the labyrinth. The process is often idiopathic, less likely to develop as a result of an infectious disease, intoxication. The debut falls on the age of 30-40 years, women are more often sick. Dizziness attacks last from a few minutes to 24 hours at a frequency from 1 time per year to several times a day. Often they are preceded by a feeling of stuffiness in the ear, severity, noise in the head, impaired coordination, etc. When seizure, severe balance disorders, vegetative disorders are observed. After the end of the attack of system dizziness in the patient for a period of several hours to several days, instability in walking, coordination disorder may persist. Characteristic of early hearing loss, usually one-sided, progressing over time, however, a complete loss of hearing is not observed. Spontaneous remissions are possible, the duration of which decreases as the disease progresses.
Vertebral-basilar insufficiency
With transient ischemic attacks in the vertebral-basilar system, there is a reversible disruption of the functions of the brainstem, cerebellum and other structures that are supplied by the branches of vertebrates and the main arteries. Transient ischemic attacks occur against the background of impaired vertebral or major arterial patency, primarily due to atherosclerotic stenosis, less often - inflammatory diseases (arteritis), vascular aplasia, extravasal compression (for example, in trauma to the cervical spine). An important cause is the destruction of arteries of small caliber due to arterial hypertension, diabetes mellitus or a combination of these. Transient ischemic attacks in the vertebral-basilar system may be harbingers of a stroke with persistent residual phenomena.
In the structure of the causes of dizziness, cerebrovascular disorders account for 6%. The immediate cause of dizziness may be defeat as the maze itself due to circulatory disorders in the vascularization zone a. Auditiva, as well as defeat in the brain stem, cerebellum, conducting systems of the cerebral hemispheres. The overwhelming majority of patients with vertebral-basilar insufficiency reveal other neurological symptoms (cranial nerve damage, conduction motor disorders, sensitive disorders, visual, static-coordinating disorders). Dizziness as the only manifestation of vascular pathology of the brain is observed extremely rarely, although it is possible with acute occlusion of the auditory artery, anterior lower cerebellar artery. In such cases, further diagnostic search is necessary to exclude other causes of dizziness. It is not necessary to relate episodes of paroxysmal dizziness that arise when the head position changes, with compression of the vertebral arteries by altered cervical vertebrae: the vast majority of these cases are DPPH.
Volumetric processes
Systemic dizziness may be caused by a tumor of the cerebelloptic corner, brainstem, cerebellum, usually neurinoma of the VIII cranial nerve, less often in this area is revealed by cholesteatoma, meningioma or metastasis. Over a certain period of time, vestibular disorders can be the only clinical manifestation of the disease, preceded by hearing disorders, and the systemic nature of dizziness is observed only in half the cases. In some cases, the cause of dizziness may be tumors of the cerebellum or the cerebral hemispheres, causing compression of the frontal-bridge and temporal-bridge pathways.
Temporal epilepsy
Repeated stereotyped unprovoked episodes of systemic dizziness accompanied by severe vegetative symptoms (fever, epigastric pain, nausea, hyperhidrosis and hypersalivation, bradycardia) may be a manifestation of temporal epilepsy. In the clinical picture of a seizure, visual hallucinations and other perceptual disorders may be present.
Migraine
It is possible to develop dizziness as an aura preceding a migraine attack. Diagnostic difficulties arise in the event that the attack of a headache is absent or unfolds in a reduced form.
Data were received on the greater frequency of migraine cases in families with RPAH.
Demyelinating diseases
Dizziness is often observed in patients with demyelinating lesions of the central nervous system, primarily with multiple sclerosis. The characteristic remitting course of the disease, multifocal lesion, the results of the examination allow us to recognize the nature of the pathological process. Diagnostic complications can arise if dizziness occurs in the onset of the disease, with the absence or moderate severity of other symptoms of damage to the brainstem, the cerebellum. Vertigo in patients with demyelinating lesions of the nervous system can be mixed, characterized by a persistent current.
[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]
Encephalitis
The defeat of the vestibular analyzer at the level of the brain stem, the cerebellum is possible with inflammatory lesions of the brain - encephalitis. A distinctive feature is the single-phase nature of the disease with acute or subacute onset and stabilization of the condition or gradual regression of symptoms. Along with vestibular disorders, the patient also reveals other signs of damage to the nervous system.
Anomalies in the development of the cervical spine and the base of the skull
Dizziness, often of a mixed nature, may occur in patients with anomalies in the development of the cervical spine and the base of the skull (platybasia, basilar impression, Arnold-Chiari syndrome), as well as with syringo-myelia (syringobulbia). The mechanisms of dizziness in this situation are complex and diverse, often their connection with developmental defects is not obvious and can be mediated by vertebral-basilar insufficiency, vestibular dysfunction.
[26], [27], [28], [29], [30], [31]
Inexhaustible dizziness
Infringements of balance
Equilibrium disorders can be caused by a complex of causes, including dysfunction of the vestibular analyzer of various genesis. An important distinctive feature is the worsening of the patient's condition with closed eyes, when the vision control is lost. When the cerebellum is affected, on the contrary, vision control is not accompanied by a decrease in the severity of ataxia. Equilibrium disorders are observed in patients with subcortical nucleus lesions, cerebral trunk (neurodegeneration, intoxication, traumatic, inflammatory, vascular disease, hydrocephalus). The cause of the disorders can be a multisensory deficit - a violation of the receipt and processing of impulses from the vestibular, visual, proprioceptive receptors. Imbalance is possible with a lack of information, in particular, from proprioceptors (polyneuropathy), with damage to the posterior columns of the spinal cord (dorsal, myelopathy). The resulting ataxia can not be corrected by vision control. Equilibrium disorders, combined with non-systemic dizziness, often arise against the use of certain drugs (benzodiazepines, phenothiazine derivatives, anticonvulsants). Vertigo is usually accompanied by increased drowsiness, impaired concentration, the severity of which decreases with a decrease in the dose of drugs.
Prescensory conditions
Non-systemic dizziness in the framework of pre-fainting (lipotymic) conditions is manifested by a feeling of faintness, instability, loss of balance. "Darkening in the eyes," ringing in the ears. These conditions may precede the development of fainting, but complete loss of consciousness may not occur. Characteristic are expressed emotional disorders - a sense of anxiety, anxiety, fear or, conversely, depression, impotence, sharp decline in strength.
Most often, such conditions occur with a decrease in systemic arterial pressure (hypersensitivity of the sinus node, vasovagal syncope, orthostatic syncope, paroxysmal arrhythmia and conduction). Many hypotensive agents, anticonvulsants (carbamazepine), sedatives (benzodiazepines), diuretics, drugs can cause lipotypic conditions levodopa. The likelihood of dizziness is increased with the combination of drugs, their use in high doses, in elderly patients, and against the background of concomitant somatic pathology. The cause of pre-fainting and fainting can also be violations of the biochemical and cytological composition of the blood (hypoglycemia, anemia, hypoproteinemia, dehydration).
Psychogenic dizziness
Psychogenic dizziness is often associated with agoraphobia, neurogenic hyperventilation. Dizziness is one of the most frequent complaints made by patients with psychogenic disorders (depressive states, hypochondriac syndrome, hysteria). Vertigo refers to the most common symptoms of panic attacks. A frequent form of psychogenic disorders of the vestibular apparatus is phobic positional vertigo, which is characterized by a sense of instability, the unsteadiness of the floor underfoot, subjective disturbances in walking and coordination of movements in the limbs in the absence of objective signs of ataxia and satisfactory performance of coordinating samples. Psychogenic dizziness is characterized by persistence, expressed emotional color. Anxiety disorders may develop over time in patients with true vestibular dizziness, which may lead to the formation of restrictive behavior in the patient.