Clinical Essentials!

The incidence of dizziness/vertigo is about 4.

Since the diagnosis of the same dizziness/vertigo patient is often different from different specialty responses, it is very important to grasp the diagnosis of vertigo

Vertigo Overview

The illusion of motion of oneself or surrounding objects caused by the illusion of spatial orientation

clinical manifestations

individual feelings

A sense of rotation (most common): turning the river upside down, turning the world upside down

– Horizontal direction: Unsteady rocking, push-pull feeling

– Vertical direction: undulations, feeling of falling

Accompanying symptoms

– Often accompanied by autonomic symptoms such as nausea, vomiting, sweating, and blood pressure fluctuations

– Do not dare to open your eyes when it is serious

– With or without nystagmus, ataxia, and rarely with neurological localization signs

Differential diagnosis

posterior circulation ischemia

There are many etiologies of atherosclerosis, and there is evidence of intracranial and extracranial atherosclerosis

Acute onset, short duration of symptoms, mostly within a few minutes or 1 hour, not more than 24 hours; symptoms include dizziness/vertigo, unsteady walking, slurred speech, difficulty swallowing, perioral numbness, etc.

Inspection method: DWI image of MRI

Benign paroxysmal positional vertigo (otolithiasis)

Onset of vertigo on head position changes: induced by the Dix-Hallpike test

The attack lasts for several seconds to 20 s, mostly within 10 s, rarely >40 s; dizziness during the attack, dizziness and heavy head may still occur when the attack does not occur, nystagmus (horizontal or rotational), and rarely nausea and vomiting; location There is a 1-2 s latency period before the change to vertigo and nystagmus

Fatigue easily, self-improvement; recurrent episodes, no hearing impairment, tinnitus and instability, without central symptoms

Hearing and temperature tests were normal

psychogenic dizziness

Dizziness (or "vertigo") exists almost every day and is persistent.
The dizziness itself does not change much.
It can be accompanied by panic attacks.
It is accompanied by many somatic symptoms.
It is greatly affected by external and emotional changes, and there are often problems with sleep and digestion
.

The onset is often emotionally motivated or stimulated, and patients are willing to exhaustively examine and treat
.
Mental status assessment showed moderate anxiety or mild depression
.

Meniere's disease

The "four main symptoms" of clinical manifestations: dizziness (recurrent episodes, several hours each time); hearing loss: obvious with the number of episodes; low-key tinnitus; feeling of fullness in the ear
.

Auxiliary diagnosis: temperature test - semicircular canal hypofunction; hearing curve - hearing loss
.

treat

general treatment

Lie down and rest in a quiet environment to avoid sound and light stimulation
.

Psychological adjustment and psychological suggestion when mentally stressed
.

If the drug is suspected, the drug should be discontinued for observation
.

Symptomatic anti-dizziness drugs

Calcium antagonists: flunarizine, nimodipine
.

Plants or traditional Chinese medicines: Yangxuenao Granules, Vertigo Ning
.

Improve circulation and antihistamine: Betahistine mesylate
.

treatment for the cause

Posterior circulation ischemia: enteric-coated aspirin, atorvastatin; diet or glycemic control
.

Otolithiasis: manual reduction + betahistine mesylate
.

Psychotic dizziness: sodium valproate extended-release tablets
.

Migraine: Rizatriptan, Zomigar
.

Hypertension: stable blood pressure
.