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Vertigo refers to a movement illusion or hallucination caused by the body's obstacles to spatial positioning
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According to statistics, the main complaint of vertigo accounts for about 5% to 10% in neurology clinics, about 6.

Vertigo refers to a movement illusion or hallucination caused by the body's obstacles to spatial positioning

 

 

Symptoms and classification of vertigo

Vertigo Symptoms and Classification In 2009, the Bárány Association Classification Committee (CCBS) divided vestibular disease symptoms into four categories: vertigo, dizziness, vestibular visual symptoms and postural symptoms (see Table 1)
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In the emergency department, dizziness is common, and some may be dizziness
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Table 1 International Classification of Vestibular Symptoms (click to enlarge) (1) Vertigo (vertigo) : (1) Vertigo (vertigo) refers to the feeling of self-movement of the head or trunk in the absence of self-movement, or in normal The distorted sense of self-movement that appears in the process of head movement is typically the rotation of the sky, and sometimes it also manifests as the feeling of shaking, tilting, up and down, bouncing up and down or sliding .
Including spontaneous vertigo and induced vertigo .
The induced vertigo includes positional vertigo, head movement-induced vertigo, visually induced vertigo, sound-induced vertigo, Valsalva motion-induced vertigo, standing vertigo and so on .
(2) Dizziness ( 2) Dizziness: Refers to the feeling of confusion or impaired head space orientation without false or distorted movement .
But there is no illusion of movement, hallucinations or distortion .
Including spontaneous dizziness and induced dizziness .
Among them, induced dizziness includes positional dizziness, dizziness induced by dizziness, visually induced dizziness, sound-induced dizziness, dizziness induced by Valsalva motion, erect dizziness, and other induced dizziness .
In addition, there are vestibulo-visual symptoms and postural symptoms.
Patients with these two types of symptoms mainly go to the outpatient clinic .
 Based on the classification of vestibular symptoms, vestibular diseases are divided into three syndromes, namely episodic vestibular syndrome (EVS), acute vestibular syndrome (AVS) and chronic vestibular syndrome (Chronic vestibular syndrome, CVS)
.
Among them, AVS and some EVS are more common in emergency department
.
AVS is generally the first onset of vertigo, with acute onset, persistent dizziness/dizziness or instability as the main symptoms, and a clinical syndrome that can last from several days to several weeks in time.
It has the characteristics of a single phase .
Common are: vestibular neuritis, acute labyrinthitis, vertigo with sudden deafness, cerebral vascular disease, EVS or acute first episode, panic attacks and so on .
AVS is generally the first onset of vertigo, with acute onset, persistent dizziness/dizziness or instability as the main symptoms, and a clinical syndrome that can last from several days to several weeks in time.
It has the characteristics of a single phase .
Common are: vestibular neuritis, acute labyrinthitis, vertigo with sudden deafness, cerebral vascular disease, EVS or acute first episode, panic attacks and so on .
Vascular EVS refers to those who have had a previous episode of vertigo, and this relapse, the symptoms lasting from a few seconds to a few hours, or even a few days .
Usually has the characteristics of repeated attacks .
Common are: benign paroxysmal positional vertigo, Meniere's disease, vestibular disorders burst, children benign paroxysmal vertigo, semicircular canal fissure syndrome, cerebrovascular disease (the TIA), vestibular migraine, and the like .
EVS refers to those who have had a previous episode of vertigo, this recurrence, and the symptoms lasted from a few seconds to a few hours, or even a few days .
Usually characterized by repeated attacks .
Common are: benign paroxysmal positional vertigo, Meniere's disease, vestibular disorders burst, children benign paroxysmal vertigo, semicircular canal fissure syndrome, cerebrovascular disease (the TIA), vestibular migraine, and the like
.
Children's Emergency vertigo examination and diagnosis process diagnostic emergency examination and diagnosis of vertigo process shown in Figure 1 .
Figure 1 Diagnosis flow chart (click to view larger image) Diagnosis and treatment of emergency vertigo General emergency treatment principles: In the emergency treatment process, first give emergency antiemetic treatment, and try to find the cause at the same time.
First, the internal medicine and central diseases are excluded, and the second is It is ear disease .
In the emergency treatment process, first give emergency antiemetic treatment, and try to find the cause at the same time.
The first exception is internal medicine and central diseases, followed by ear diseases .
Because patients with vertigo sometimes fail to pay attention to hearing, hearing loss can lead to hearing disability if hearing treatment is not timely, so sudden deafness must be excluded from the first episode of AVS .
For those with long-term and severe dizziness, especially those with more severe autonomic reactions such as nausea, vomiting and sweating, vestibular inhibitors can be used for a short period of time (recommendation strength: B; evidence level: Ⅱ) to control the symptoms of vertigo (in principle, use no more than 72h), antiemetic treatment can be used if necessary (Recommendation strength: A; Evidence level: II) .
Commonly used drugs are promethazine hydrochloride, difenidol hydrochloride tablets, diphenhydramine hydrochloride and so on .
See Table 2 .
Acute-onset vertigo can be used as appropriate to improve the circulation of drugs such as gastrodin (Tianxuanqing), ginkgo biloba preparations, betahistine, etc.
(Recommendation strength: B; Evidence level: IV) .
Table 2 Commonly used drugs (click to view larger image) 
  Central vertigo, acute cerebrovascular disease - acute cerebrovascular disease - for hyperacute cerebral infarction, those who meet the indications are given emergency intravenous thrombolysis (alteplase, urokinase), intravascular interventional therapy and other rescue measures.
Those who have lost the chance of recanalization can be treated according to TOAST classification and treated with antiplatelet or anticoagulation, lipid lowering, control of risk factors, and plaque stabilization (statins)
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For patients with cerebral hemorrhage - for patients with cerebral hemorrhage -the main treatment measures are dehydration to lower intracranial pressure, control blood pressure and prevent complications.
For those with a certain space-occupying effect, dehydration treatment such as mannitol or glycerol fructose should be given, if necessary.
Surgical treatments such as decompression and bone removal
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Vestibular migraine- vestibular migraine- mainly to give symptomatic treatment such as analgesia and antiemetics
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Demyelinating diseases of the CNS - central nervous system demyelinating disease - glucocorticoid or immune globulin immunomodulatory treatment
.
Immune Central Nervous System Infection - Central Nervous System Infection - Before obtaining the exact etiological evidence for infection , antiviral (acyclovir, ganciclovir, etc.
) and antibacterial (ceftriax) can be given empirically according to its clinical characteristics Sodium pine, cefotaxime, etc.
) and dehydration to lower intracranial pressure and other symptomatic and supportive treatments
.
Space-occupying lesions of the fourth ventricle and cerebellum——Space-occupying lesions of the fourth ventricle and cerebellum- These space-occupying lesions will not present acute or paroxysmal manifestations in the early stage.
When the tumor is large enough, it will manifest as acute dizziness (dizziness), which needs attention .
See Table 3 .
Table 3 Emergency central vertigo and the main treatment of dizziness caused by systemic diseases.
The systemic factors leading to dizziness involve multiple systems, such as water and electrolyte balance disorders, cardiovascular diseases (such as orthostatic hypotension, arrhythmia , heart failure, etc.
), endocrine diseases (Such as hypoglycemia , hyperthyroidism or hypothyroidism) blood system diseases (such as anemia, etc.
), autoimmune diseases (systemic lupus erythematosus, etc.
) and drug poisoning, etc.
, cardiovascular arrhythmia and hypoglycemia should be treated symptomatically according to the specific conditions of the patient , And please consult the relevant department at the same time .
Peripheral vertigo Psychological vertigo- mental and psychological vertigo- can be seen in panic attacks or generalized anxiety disorder, alprazolam, lorazepam, etc.
can be given .
See Table 4 .
Table 4 The main treatment plans for common peripheral vertigo in emergency department .
The evidence-based grades and recommended grades in the article are shown in Table 5 and Table 6 .
The evidence-based grades and recommended grades in the article are shown in Table 5 and Table 6 .
Table 5 Classification of clinical recommendations Table 6 Level of evidence-based evidence Leave a message here