8 pictures teach you to master the basic skills of vertigo

If you want to be optimistic about vertigo disease, solid basic skills are the prerequisites
.
The basic knowledge of vertigo involves multidisciplinary knowledge such as neurology, ophthalmology, osteology, and psychopsychology, how to quickly have a preliminary understanding of vertigo diseases? We can start with symptoms, physical examinations, and common syndromes
.
Here are 8 mind maps for everyone, involving the international classification of vestibular diseases, the classification of vestibular signs, bedside examination, common vestibular syndrome and the four major laws
related to vestibular diseases.

Author: Tinyel

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International Classification of Vestibular Diseases

The first level of vestibular symptoms in the International Classification of Vestibular Diseases (ICVD) includes four core symptoms: dizziness, vertigo, vestibulo-visual symptoms, and postural symptoms
.
In this category, dizziness and vertigo can exist at the
same time.

In the dizziness (dizziness) symptoms of the second stage vestibular symptoms, positional, head movement, orthostatic vertigo (dizziness) need to be carefully identified, where positional vertigo (dizziness) refers to the appearance of symptoms after the head arrives and remains in a new position, and shorter positional vertigo (dizziness) needs to be distinguished from orthostatic vertigo (dizziness), the key point of identification is whether the patient also has symptoms when lying down, and if symptoms appear, it is positional; Orthostatic vertigo (dizziness) is the appearance of symptoms when the body is upright; Agitated vertigo (dizziness) is the occurrence of symptoms during head movements or a pre-existing spontaneous vertigo (dizziness) that is exacerbated
by head movements.

In the vestibule-visual symptoms of the second stage of vestibular symptoms, it is important to note that visual tilt is stationary, and if it is moving, it should not be classified as visual tilt, but as a visual sensation of external vertigo, or a physical sensation
of internal vertigo.

In postural symptoms, it is important to note that both unstable and directional tipping symptoms can be significantly alleviated or disappeared after leaning against a wall or holding an object, and if this is not met, it cannot be considered unstable or directional dumping, and the patient should be considered dizziness or dizziness
.

Nystagmus and nysaur-like movements

For nystagmus, first of all, we must clarify the definition of nystagmus, and secondly, we need to know the conjugation of nystagmus and the effect of solid vision on nystagmus, but the ability of solid vision will be affected by some factors, when the patient can not be fixed visual inhibition, to clarify the patient's baseline vision, in addition, you need to pay attention to the difference between nystagmus and nystagmus-like movement, some eye movements are similar to nystagmus, but not nystagmus, often prompt central problems, need to identify
。 When observing the nystagmus, first of all, the reference frame is selected, no matter what the reference frame is, the axis of rotation is perpendicular to the vestibular (rotation) plane, and it is necessary to pay attention to the direction of the nystagmus from the patient's point of view, and it is best not to use "clockwise" and "counterclockwise" to describe, but to describe
it with the extreme reference point on the eyeball, with the eye rotated to a certain ear.

The axis of rotation and the forecourt (rotation) plane

Bedside check-up

Bedside examination of patients with vertigo should not ignore the general physical examination, in which the blood pressure in the supine position, although affected by other factors, should still be checked; Preliminary examination of the heart can exclude cardiogenic vertigo (dizziness); At the same time, the initial screening of mental illness should not be ignored, and a simple screening
can be carried out using a scale.
Eye examination is the focus of the bedside examination, first of all, to observe whether the eyes are consistent in the horizontal and vertical directions, there are many methods that can be used to check the presence of strabismus, and 9 eye positions should be checked instead of just 4 directions, and the presence of gaze-induced nystagmus can be checked at the same time when checking 9 eye positions; In positional tests, the Dix-hallpike test and the Roll-test must present with characteristic nystagmus to be used to diagnose BPPV
in the corresponding semicircular canal.

The Four Laws

The four major laws include Alexander's law and Ewald's law I.
-III.
, of which Ewald's law I is also called Flourens' law
.
These four laws are one of
the foundations for understanding nystagmus.

Vestibular syndrome

Vestibular syndromes can be divided into episodic, acute, and chronic
.
Episodic vestibular syndrome (EVS) contains recurrent vestibular diseases and dysfunction, acute vestibular syndrome (AVS) contains diseases with vestibular signs and symptoms of a single sudden onset, and chronic vestibular syndrome (CVS) contains diseases and dysfunction
that last longer than a certain standard.

summary

Only by clarifying the definition of vertigo-related symptoms can we conduct scientific consultation on the patient, understand whether the symptoms described by the patient are vertigo or dizziness, only by mastering the methods of relevant physical examination and observation of related signs, can we quickly make a diagnosis, only by understanding the common syndromes and included diseases can we achieve a clear differential diagnosis, and truly cultivate the basic skills of vertigo to begin the diagnosis and treatment
of vertigo diseases.

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