The diagnosis process and ideas of dizziness are thoroughly explained!

*Only for medical professionals to read and refer to the diagnosis of dizziness, the first step to clarify the cause! Dizziness is a common brain functional disorder, manifested by feelings of dizziness, swelling, light head-heavy, shaking in the brain, and vertigo.

The "dizziness" described by patients is often divided into 4 types, namely, A.
Dizziness; B.
Syncope or pre-syncope; C.
Atypical dizziness; D.
Unsteady walking.

For patients who complain of "dizziness", we must first clarify which type it is, and then further clarify the specific reasons for each type.

Dizziness involves many disciplines such as otolaryngology, neurology, neurosurgery, orthopedics, ophthalmology, internal medicine, geriatrics, and psychiatry, because the specialization of various clinical disciplines may cause the disconnection of multidisciplinary connections, and the causes of dizziness are diverse and complex Therefore, when diagnosing dizziness, it is necessary to follow a complete and orderly process to avoid misdiagnosis and missed diagnosis.
At the same time, it can speed up the diagnosis and avoid delays in the treatment of serious diseases that cause dizziness.

Flowchart of dizziness diagnosis The diagnosis of dizziness starts with the diagnosis process of dizziness.
Patients who complain of "dizziness" should be asked about their medical history and physical examination to determine which type of "dizziness" belongs to.

For the 4 different types of "dizziness", further related auxiliary examinations need to be arranged until the specific cause and diagnosis of "dizziness" are clear.

Therefore, in theory, all "dizziness" has a cause, and the cause needs to be clarified.

If the patient's "dizziness" is due to insufficient medical conditions If it cannot be relieved, and it gradually worsens, affecting life and work, it should be transferred to a higher-level hospital for further diagnosis and treatment.

If neurological, otogenic, and physical dysfunction cannot be found, but there are mental and psychological factors, after the evaluation of mental and psychological scales such as depression and anxiety, the diagnosis of depression or anxiety can be considered based on the actual examination results.
Try anti-depressant or anti-anxiety medications.For patients with "dizziness", the diagnosis process can be divided into the following steps: (1) Determine whether it is dizziness (type A "dizziness").

Vertigo is a subjective feeling of relative movement between the body and external objects caused by pathological changes around the vestibular nerve and central pathways.

It is manifested as opening the eyes and discovering that the surrounding objects are moving (up and down, horizontal, rotating, etc.
), and the body feels unstable or drifting when closing the eyes.

(2) For non-vertigo "dizziness" patients, first determine whether the dizziness is syncope or pre-syncope (type B "dizziness").

Syncope is a transient loss of consciousness caused by insufficient cerebral perfusion (conventional concepts include hypoglycemia and hypoxemia).

For those without loss of consciousness, it is called pre-syncope.

The main causes include cardiogenic and cerebrovascular disease caused by hypoperfusion, vagal reflex blood pressure reduction, hypoglycemia, and hypoxemia (such as carbon monoxide poisoning).

(3) For patients with non-vertigo and non-syncope, it is necessary to determine whether it is caused by neurological diseases or other physical diseases (such as osteoarthropathy) caused by walking instability (type C "dizziness"), such as peripheral neuropathy, deep paresthesia, Vestibular cerebellar disease, unstable walking caused by brain disease, etc.

It is necessary for the doctor to conduct detailed neurological history inquiry, physical examination and related auxiliary examinations from the central nervous system to the skeletal muscles.

(4) For patients with non-vertigo, non-syncope, and diseases that cause walking instability are excluded, they are classified as atypical dizziness (type D "dizziness"), and need to further evaluate their physical health to exclude important organ diseases, especially It is a life-threatening disease (abnormal vital signs appear).

(5) After excluding the above-mentioned organic diseases, it is necessary to look for psychogenic factors, "dizziness" It can also be considered that it is caused by mental and psychological factors, such as depression and anxiety.

Diagnosis process of dizziness in the elderly The diagnosis process of dizziness in the elderly should start with detailed inquiry and recording of medical history and medication history.
A comprehensive and careful physical examination and necessary auxiliary examinations can help confirm the diagnosis.
For patients with complex conditions, supplementary auxiliary examinations can be differentiated.
Diagnostic value. Auxiliary examinations for dizziness include audiology, vestibular function, fundus, electrocardiogram, and imaging examinations.

Diagnose dizziness related diseases first through the diagnosis of related diseases, combined with audiology, positional vertigo, and imaging examinations.

Dizziness patients can be divided into dizziness with normal hearing and dizziness with abnormal hearing according to the presence or absence of deafness.

Dizziness with normal hearing includes: ①Most non-ear-derived dizziness diseases, such as orthostatic hypotension, cervical dizziness, etc.
; ②Vestibular neuritis and benign paroxysmal positional vertigo in otic dizziness.

Dizziness with hearing abnormalities include: ①Dizziness diseases with conductive deafness, such as otosclerosis, labyrinthine fistula; ②Dizziness diseases with sensorineural hearing loss, such as Meniere's disease and cerebellopontine angle area occupying.

Most elderly people are often accompanied by senile deafness caused by auditory degeneration, which is characterized by symmetrical high-frequency decline in both ears.
It is worth noting when analyzing the results of audiological examinations to determine the location of dizziness in the elderly.

In the diagnosis process of dizziness in the elderly, audiology examination is a necessary auxiliary examination.
For patients with refractory or intractable dizziness, vestibular function examination is a supplementary auxiliary examination.

Dizziness patients are classified into non-positional vertigo and positional vertigo according to whether they show dizziness with head position changes.

Benign paroxysmal positional vertigo is a kind of positional vertigo.
Its diagnosis and treatment depend on the characteristics and changes of nystagmus in the position-induced nystagmus test.
Dix-hallpike mainly targets the posterior and anterior semicircular canals, and the rolltest test targets the horizontal semicircular canals.
.

Benign paroxysmal positional vertigo can occur on one side, two sides, single site, and multiple sites.

Non-benign paroxysmal positional vertigo diseases that can cause positional vertigo also include cervical spondylosis, fourth ventricle tumors, congenital malformations of the skull base, and craniocerebral central nervous system tumors that need to be differentiated.

In clinic, some elderly dizziness does not appear as a single disease.
Some patients with non-positional vertigo, such as Meniere’s disease, vestibular neuritis, etc.
, may be combined with benign paroxysmal positional vertigo or cervical spondylosis during the course of the disease.
Difficulty in the diagnosis and differential diagnosis of dizziness. In the general dizziness diagnosis process, imaging examinations are mostly supplementary auxiliary examinations.
Because elderly dizziness patients have many basic diseases, involving the heart and cerebrovascular, their condition is complex and rapid, so it emphasizes its clinical application in the diagnosis and treatment of dizziness in the elderly.
effect.

Head MRI weighted diffusion imaging can help determine vascular lesions, space-occupying lesions and skull base deformities.

It is generally believed that dizziness in the elderly with normal cranial magnetic resonance is benign dizziness, and dizziness in the elderly with abnormal cranial magnetic resonance is potentially dangerous or malignant dizziness.

Diagnosis and treatment of dizziness is a complicated process.
Through medical history, physical examination, necessary auxiliary examinations, and in accordance with the scientific and practical preliminary diagnosis process, most elderly people with dizziness will get reasonable diagnosis and treatment and recover.

References: [1] Dizziness diagnosis process recommendations expert group, Li Yansheng, Wu Ziming.
Dizziness diagnosis process recommendations[J].
Chinese Journal of Internal Medicine,2009,48(05):435-437.
[2].
The elderly The initial diagnosis process of dizziness[J].
Chinese Journal of Geriatrics,2013,32(07):692-694.
[3]Gong Tao.
The diagnosis process of dizziness[J].
Chinese Journal of General Practitioners,2014,13(12 ):961-964.
Source of this article: Nerve News.
Review of this article: Li Tuming, Deputy Chief Physician.
Editor in Charge: CiCi Copyright Statement.
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