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At present, the commonly used vertigo classification in China is divided into the following types:
intrinsic vertigo refers to the feeling of self-movement when there is no self-movement, or the feeling of self-movement that is distorted during normal head movement, in short, the feeling that oneself is moving (not actually moving), which is different from external vertigo, which refers to the "external" visual motor sensation or oscilloscope [vestibular visual symptoms, in short, seeing something moving (in fact neither you nor the thing moving)].
Intrinsic vertigo includes false spinning sensations (spinning vertigo) and other false sensations such as rocking, tilting, swinging up and down, jumping, or sliding
.
The proper motor sensation that occurs during exercise is not vertigo
.
Here, either the wrong sensation of rotational motion, the wrong feeling of linear motion (often referred to as "translation"), or "tilt" is considered vertigo
.
The feeling of swaying is felt only when standing or walking, and this sensation is called instability and is defined as a postural symptom, not vertigo
.
Internal sensations of vertigo with a false sense of external visual movement (external vertigo or oscilloscope) are considered to have combined vestibular visual symptoms (e.
g.
, "internal and external rotational vertigo" or "non-rotational vertigo with oscillography").
False visual-motor sensations that occur in isolation (without false internal self-kinematic sensations) can only be labeled as external vertigo or oscilloscope.
The possible pathogenesis is mainly damage to the vestibulo-eye reflex (VOR) pathway, unilateral damage, and more common
in the acute phase.
Intrinsic vertigo should be further classified as rotary, non-rotating, or both
.
without an obvious trigger.
Spontaneous vertigo may be exacerbated
by movement, especially head movement.
When spontaneous vertigo is aggravated by head movement, consider concomitant head motion vertigo
.
Common in vestibular system diseases such as vestibular neuritis, vestibular migraine, Meniere's disease, etc
.
caused by obvious predisposing factors.
It is important to note here that the presence of "obvious" predisposing factors requires a temporal correlation
between the provoked stimulus and vertigo.
In most cases, there is a replicable, repeatable relationship
between the induced stimulus and vertigo episodes.
Note that although chemically predisposing factors (eg, food, hormonal status, medications) may contribute to spontaneous vertigo in certain vestibular disorders (eg, vestibular migraine or Meniere's disease), However, precipitated vertigo is considered to be predisposed only if there is a clear correlation between the predisposing factor and the episode of vertigo
.
Precipitated vertigo can be seen in temperature stimuli, mechanical rotation or vibration stimulation, electrical stimulation, such as benign positional episodic vertigo (BPPV), superior semicircular canal fissure, etc
.
■2.
1.
Positional vertigo Positional vertigo is vertigo
caused by a change in the position of gravity space in the head.
Note: This is not the same
as vertigo that occurs when the head is moved.
When the head arrives and is fixed in a new position, the duration of vertigo symptoms is (≥ 1 minutes) or transient (< 1 minutes),</b122> that occurs only with head movement vertigo may be caused by head movement is a type of vertigo or vibrations caused by Valsalva .
Orthostatic vertigo to vertigo caused by the production vertigo () should be distinguished from positional vertigo (caused by changes and motile vertigo, as (), exercise (),
(non-vertigo) Dizziness refers to impaired or impaired spatial orientation but no false or distorted sense of movement
.
Dizziness does not contain dizzy sensations
.
Both symptoms of dizziness and vertigo may occur in the same patient or sequentially
.
When the patient has presyncope state, confusion of thinking, etc.
, there is no sense of spatial disorientation, and dizziness should not be described
.
Similarly, dizziness is not indicated in patients
who complain of generalized or focal fatigue, or nonspecific malaise, fatigue, or sub-health symptoms.
The possible pathogenesis is mainly damage to the vestibular VOR pathway, which is mild, symmetrically damaged, and more common in the convalescent period and central segment
.
that has no obvious trigger.
When spontaneous dizziness is aggravated by movement, especially head movement, it becomes ambulatory dizziness
.
caused by a clear trigger.
The presence of an "explicit" trigger requires a temporal correlation
between the trigger stimulus and dizziness.
■2.
1 Positional dizziness Positional dizziness refers to dizziness
caused by changes in the position of the head space relative to gravity.
This is different
from the dizziness that occurs during head movement.
When the head reaches and remains in a new position, persistent dizzy episodes ≥ 1 minute and transient dizzy episodes < 1 minute<b22>.
■ 2.
2 Head-moving dizziness, that is, head motor dizziness
, refers to a distorted spatial orientation sensation
in the actual self-movement process.
This state differs from positional dizziness, which occurs after head movement, adopting a new resting state in the space of the head position
.
Dizziness caused by head movement should also be distinguished from motion sickness, whose main symptom is a persistent, visceral nausea
.
■ 2.
3 Visually Induced Dizziness Visually-induced dizziness is dizziness
caused by complex, distorted, large visual field or moving visual stimuli, including relative movements
around the vision associated with body movement.
Visual induced vertigo
is diagnosed if visual input causes clear circular or linear vision.
If disturbing visual input is due to dizziness due to primary ocular movement disorders such as ophthalmospasm or nonvestibular nystagmus, symptoms should be classified
here.
■ 2.
4 Sound-induced dizziness Sound-induced dizziness is dizziness
caused by auditory stimuli.
■2.
5 Valsalva-induced dizziness Valsalva-induced dizziness refers to dizziness
induced by any physical action that increases intracranial pressure or middle ear pressure.
Classic stimulation (including coughing, sneezing, nervousness, lifting heavy objects, etc.
) is often done by increasing intrathoracic pressure through a closed glottis (glottis valve) to reduce intracranial venous return
.
In contrast, the pinched nose Valsalva forces air directly into the middle ear cavity without significant changes in intrathoracic pressure
.
Therefore, it is necessary to distinguish whether dizziness is caused by glottis valsalva, pinching valsalva, or a combination of both, pneumatic otoscopy/inflation and other "external" pressure changes induced dizziness should be classified as other triggering dizziness
.
■2.
6.
Orthostatic dizziness Orthostatic vertigo refers to dizziness
caused by the change of posture of the body from a lying position to a sitting or standing position.
Orthostatic dizziness (present at the time of the attack) should be distinguished from positional dizziness (caused by changes in head position relative to gravity) and dizziness caused by head movement, as positional symptoms may be caused
by head movements that occur at the time of the attack.
The difference between positional dizziness and orthostatic dizziness can be achieved by asking the person with dizziness whether they also experience dizziness symptoms while lying down (such as when rolling in bed); If so, symptoms may be positional rather than upright
.
While the most common cause of orthostatic dizziness may be orthostatic hypotension, it's not the only cause
.
Orthostatic dizziness is a symptom, while orthostatic hypotension is a disease or cause
.
■ 2.
7.
Dizziness induced by other factors Dizziness induced by other factors is dizziness
caused by stimuli other than the above stimuli factors.
Other triggers include problems with dehydration, medications, changes in environmental stress (eg, deep-sea diving, height, hyperbaric oxygen, inflation on aeroscopy), exercise/motor (including upper extremity exercise), prolonged exposure to passive exercise (e.
g.
, after sea navigation), hormones, hyperventilation, fear, Triggers associated with stress, collars, vibrations, and specific, patient-specific atypical triggers
.
The vestibular-visual symptom is a visual symptom
usually caused by vestibular pathology or the interaction of the visual and vestibular systems.
These symptoms include faulty motor or tilting sensations around the visual area, as well as visual distortions (blurring)
related to the vestibule (rather than optical).
Note: Optical illusions or visual hallucinations involve the movement of objects around vision, but the visual surroundings themselves remain stationary and should not be considered vestibular vision symptoms
.
For example, seeing mobile vision such as "floaters" and migratory flashes of migraine visual aura often indicate damage
to the vestibular VOR pathway.
that the visual surroundings are spinning or flowing.
Note: Symptoms of external vertigo include the illusion of continuous or intense visual flow on any spatial plane (e.
g.
, horizontal).
It differs from oscillation in that there is no bidirectional (oscillating) movement
.
External vertigo (visual movement) is usually accompanied by a feeling of internal vertigo (body movement).
However, even if there is no false feeling of nystagmus (internal vertigo), a violent nystagmus alone may cause a persistent sense of
visual flow.
that a fixed object around it is perceived as motion.
It is manifested as difficulty reading the text
on the sign when walking.
This symptom occurs by vestibulo-ocular reflex abnormalities, commonly in vestibular, brainstem, or cerebellar lesions, and occasionally ophthalmoplegia or visual cortex lesions
.
The duration of visual oscillation is brief in unilateral peripheral acute vestibular injury, and the symptoms of visual oscillation may be persistent in central vestibular pathway lesions, often with other symptoms and signs
of brainstem damage.
Oscillations are most common in bilateral vestibular diseases, such as bilateral idiopathic vestibular disease, familial vestibular disease, and recurrent vestibular disease
.
is completed.
This symptom is transient and usually lasts ≤ 1-2 seconds
.
It may be accompanied by ambulatory vertigo or dizziness
.
that the surrounding scene deviates from the vertical line.
This symptom is typically episodic and transient (lasting from a few seconds to a few minutes).
The so-called "room tilt illusion" (or "room inversion illusion") is often used to refer to a special tilt angle of 90◦ or 180◦, although the term visual tilt (with a specified approximate angle) is preferred
.
If the sensation of visual tilt is motor (i.
e.
angular change) and not fixed (i.
e.
, fixed angle), then it should be called external vertigo (visual sensation) or (internal) vertigo (physical sensation) instead of visual tilt
.
Also known as room tilt illusion, room inversion illusion, inverted vision
.
.
The vestibulo-ocular reflex contributes to the stabilization of retinal images during head movement, a dysfunction that can lead to retinal slippage, resulting in decreased
vision during or immediately after head movement.
This visual blurring may persist during sustained head movements (e.
g.
, during walking) or may be transient (e.
g.
, related to head motor vertigo or dizziness).
In these cases, some people experience visual oscillation or visual delay instead of blurred
vision.
associated with maintaining postural stability and occur only when
standing upright (sitting, standing, or walking).
In this nomenclature, "posture" refers to the symptoms of balance when standing upright (e.
g.
, standing), rather than the set of symptoms associated with changes in gravity due to changes in body posture (e.
g.
, standing up), which is called "orthodism.
"
Often suggests impaired
vestibulospinal reflex (VSR) pathway.
.
Note: Regardless of the upright posture (sitting, standing, or walking), increasing stability (e.
g.
, maintaining a stable surface, such as a wall) should significantly reduce or eliminate any instability; If not, the symptom should be considered to be vertigo or dizziness
.
Instability is a symptom that can occur in many other conditions than vestibular system disorders
.
If instability is present but there are no other vestibular symptoms, it is unlikely to be considered a vestibular system disease
.
of being unstable or deviating from a particular direction while sitting, standing, or walking.
The direction should be specified as sideways, forward, or backward
.
If the side is dumped, the direction (right or left)
should be specified.
Note: Regardless of the upright position (sitting, standing, or walking), increasing stability (e.
g.
, maintaining a stable surface, such as a wall) should significantly reduce or eliminate any directional rejection; If not, symptoms should be considered as dizziness or lightheadedness
.
A fall that is "caught" (e.
g.
, being extended to a wall by an outstretched arm) should be classified as close to a fall
.
Due to environmental disturbances (e.
g.
, "falls"), weakness (e.
g.
, fatigue, lower leg flexion), or near-loss of consciousness (e.
g.
, before syncope).
Resulting close falls should not be classified as balance-related
.
Near-falls are sometimes due to sudden changes in verticality perception (eg, visual tilt), a feeling of being pushed or pulled toward the ground, or a sudden loss of postural tone in the lower extremities associated with other vestibular symptoms
.
In neurootology, this is called "otolith crisis" or "stroke attack.
"
.
Falls related to balance should not be classified as due to environmental disturbances (e.
g.
, "slippage"), weakness (e.
g.
, acute motor stroke), or loss of consciousness (e.
g.
, syncope, seizures, or coma
).
In neurootology, this is called "otolith crisis" or "stroke attack.
"
attributed to vestibular-visual symptoms.
Indicates that dizziness is not used to describe feelings of confusion, presyncope and syncope, weakness, lightheadedness, and detachment from reality, and the terms
non-specific dizziness and lightheadedness are no longer used.
Secondly, when studying vertigo/dizziness, it is necessary to pay attention to whether it is spontaneous or provoked seizures, further clarify the concepts of positionality and erectity, and abandon the concepts
of displacement and posture.
In addition, attention should be paid to vestibular-visual symptoms such as false sense of movement, visual tilt, and blurred vision due to vestibular function decline, which are often ignored clinically
.
It is also pointed out that terms such as fall attack and otolith crisis are no longer used, and are uniformly defined as balance-related near-falls and falls
.
Standardizing the understanding and application of vestibular symptomatic classification is a prerequisite
for vertigo work, clinical communication, and accurate and comprehensive medical history.
In order to better provide a diagnostic basis for clinical diagnosis and treatment and clarify the pathogenesis, in 2015, Barany Society published the International Classification of Vestibular Diseases, which we will learn more about
in the next issue.
Where to see more vertigo knowledge?
Come to the "doctor's station" and take a look 👇
Full of dry goods, hurry up and collect!
At present, the commonly used vertigo classification in China is divided into the following types:
1.
DeWeese classification according to anatomical parts
: divided into vestibular systemic vertigo (systemic vertigo) and non-vestibular systemic vertigo (non-systemic vertigo);
2.
Edward classification, divided into intracranial vertigo and extracranial vertigo;
Second, according to the classification of diseased organs, it is divided into otogenic, vascular, central, cervical and visual;
Third, according to the nature of vertigo, it is divided into true vertigo (caused by eye, proprioceptive or vestibular diseases, with obvious sense of rotation) and pseudovertigo (caused by systemic diseases).
The definition of vertigo is one of the core contents of the diagnosis and treatment of vertigo, and the main basis for the diagnosis of vestibular disease is symptoms, which is the premise of the correct diagnosis of vertigo, and the correct understanding and definition of vestibular symptoms is the basis for
professional communication.
Due to problems with the terminology currently used to describe basic concepts such as dizziness and vertigo, in 2009 the Barany Society published an international classification
of vestibular symptoms.
According to the international vestibular symptoms, it can be divided into (1) vertigo; (2) dizziness; (3) vestibulo-visual symptoms; (4) Postural symptoms
.
1
Vertigointrinsic vertigo refers to the feeling of self-movement when there is no self-movement, or the feeling of self-movement that is distorted during normal head movement, in short, the feeling that oneself is moving (not actually moving), which is different from external vertigo, which refers to the "external" visual motor sensation or oscilloscope [vestibular visual symptoms, in short, seeing something moving (in fact neither you nor the thing moving)].
Intrinsic vertigo includes false spinning sensations (spinning vertigo) and other false sensations such as rocking, tilting, swinging up and down, jumping, or sliding
.
The proper motor sensation that occurs during exercise is not vertigo
.
Here, either the wrong sensation of rotational motion, the wrong feeling of linear motion (often referred to as "translation"), or "tilt" is considered vertigo
.
The feeling of swaying is felt only when standing or walking, and this sensation is called instability and is defined as a postural symptom, not vertigo
.
Internal sensations of vertigo with a false sense of external visual movement (external vertigo or oscilloscope) are considered to have combined vestibular visual symptoms (e.
g.
, "internal and external rotational vertigo" or "non-rotational vertigo with oscillography").
False visual-motor sensations that occur in isolation (without false internal self-kinematic sensations) can only be labeled as external vertigo or oscilloscope.
The possible pathogenesis is mainly damage to the vestibulo-eye reflex (VOR) pathway, unilateral damage, and more common
in the acute phase.
Intrinsic vertigo should be further classified as rotary, non-rotating, or both
.
01
Spontaneous vertigo refers to vertigowithout an obvious trigger.
Spontaneous vertigo may be exacerbated
by movement, especially head movement.
When spontaneous vertigo is aggravated by head movement, consider concomitant head motion vertigo
.
Common in vestibular system diseases such as vestibular neuritis, vestibular migraine, Meniere's disease, etc
.
02
Definition of provoked vertigo: Provoked vertigo refers to vertigocaused by obvious predisposing factors.
It is important to note here that the presence of "obvious" predisposing factors requires a temporal correlation
between the provoked stimulus and vertigo.
In most cases, there is a replicable, repeatable relationship
between the induced stimulus and vertigo episodes.
Note that although chemically predisposing factors (eg, food, hormonal status, medications) may contribute to spontaneous vertigo in certain vestibular disorders (eg, vestibular migraine or Meniere's disease), However, precipitated vertigo is considered to be predisposed only if there is a clear correlation between the predisposing factor and the episode of vertigo
.
Precipitated vertigo can be seen in temperature stimuli, mechanical rotation or vibration stimulation, electrical stimulation, such as benign positional episodic vertigo (BPPV), superior semicircular canal fissure, etc
.
■2.
1.
Positional vertigo Positional vertigo is vertigo
caused by a change in the position of gravity space in the head.
Note: This is not the same
as vertigo that occurs when the head is moved.
When the head arrives and is fixed in a new position, the duration of vertigo symptoms is (≥ 1 minutes) or transient (< 1 minutes),</b122> that occurs only with head movement vertigo may be caused by head movement is a type of vertigo or vibrations caused by Valsalva .
Orthostatic vertigo to vertigo caused by the production vertigo () should be distinguished from positional vertigo (caused by changes and motile vertigo, as (), exercise (),
2
Dizziness(non-vertigo) Dizziness refers to impaired or impaired spatial orientation but no false or distorted sense of movement
.
Dizziness does not contain dizzy sensations
.
Both symptoms of dizziness and vertigo may occur in the same patient or sequentially
.
When the patient has presyncope state, confusion of thinking, etc.
, there is no sense of spatial disorientation, and dizziness should not be described
.
Similarly, dizziness is not indicated in patients
who complain of generalized or focal fatigue, or nonspecific malaise, fatigue, or sub-health symptoms.
The possible pathogenesis is mainly damage to the vestibular VOR pathway, which is mild, symmetrically damaged, and more common in the convalescent period and central segment
.
01
Spontaneous dizziness refers to dizzinessthat has no obvious trigger.
When spontaneous dizziness is aggravated by movement, especially head movement, it becomes ambulatory dizziness
.
02
Provoked dizziness Induced dizziness refers to dizzinesscaused by a clear trigger.
The presence of an "explicit" trigger requires a temporal correlation
between the trigger stimulus and dizziness.
■2.
1 Positional dizziness Positional dizziness refers to dizziness
caused by changes in the position of the head space relative to gravity.
This is different
from the dizziness that occurs during head movement.
When the head reaches and remains in a new position, persistent dizzy episodes ≥ 1 minute and transient dizzy episodes < 1 minute<b22>.
■ 2.
2 Head-moving dizziness, that is, head motor dizziness
, refers to a distorted spatial orientation sensation
in the actual self-movement process.
This state differs from positional dizziness, which occurs after head movement, adopting a new resting state in the space of the head position
.
Dizziness caused by head movement should also be distinguished from motion sickness, whose main symptom is a persistent, visceral nausea
.
■ 2.
3 Visually Induced Dizziness Visually-induced dizziness is dizziness
caused by complex, distorted, large visual field or moving visual stimuli, including relative movements
around the vision associated with body movement.
Visual induced vertigo
is diagnosed if visual input causes clear circular or linear vision.
If disturbing visual input is due to dizziness due to primary ocular movement disorders such as ophthalmospasm or nonvestibular nystagmus, symptoms should be classified
here.
■ 2.
4 Sound-induced dizziness Sound-induced dizziness is dizziness
caused by auditory stimuli.
■2.
5 Valsalva-induced dizziness Valsalva-induced dizziness refers to dizziness
induced by any physical action that increases intracranial pressure or middle ear pressure.
Classic stimulation (including coughing, sneezing, nervousness, lifting heavy objects, etc.
) is often done by increasing intrathoracic pressure through a closed glottis (glottis valve) to reduce intracranial venous return
.
In contrast, the pinched nose Valsalva forces air directly into the middle ear cavity without significant changes in intrathoracic pressure
.
Therefore, it is necessary to distinguish whether dizziness is caused by glottis valsalva, pinching valsalva, or a combination of both, pneumatic otoscopy/inflation and other "external" pressure changes induced dizziness should be classified as other triggering dizziness
.
■2.
6.
Orthostatic dizziness Orthostatic vertigo refers to dizziness
caused by the change of posture of the body from a lying position to a sitting or standing position.
Orthostatic dizziness (present at the time of the attack) should be distinguished from positional dizziness (caused by changes in head position relative to gravity) and dizziness caused by head movement, as positional symptoms may be caused
by head movements that occur at the time of the attack.
The difference between positional dizziness and orthostatic dizziness can be achieved by asking the person with dizziness whether they also experience dizziness symptoms while lying down (such as when rolling in bed); If so, symptoms may be positional rather than upright
.
While the most common cause of orthostatic dizziness may be orthostatic hypotension, it's not the only cause
.
Orthostatic dizziness is a symptom, while orthostatic hypotension is a disease or cause
.
■ 2.
7.
Dizziness induced by other factors Dizziness induced by other factors is dizziness
caused by stimuli other than the above stimuli factors.
Other triggers include problems with dehydration, medications, changes in environmental stress (eg, deep-sea diving, height, hyperbaric oxygen, inflation on aeroscopy), exercise/motor (including upper extremity exercise), prolonged exposure to passive exercise (e.
g.
, after sea navigation), hormones, hyperventilation, fear, Triggers associated with stress, collars, vibrations, and specific, patient-specific atypical triggers
.
3
Vestibular-visual symptomsThe vestibular-visual symptom is a visual symptom
usually caused by vestibular pathology or the interaction of the visual and vestibular systems.
These symptoms include faulty motor or tilting sensations around the visual area, as well as visual distortions (blurring)
related to the vestibule (rather than optical).
Note: Optical illusions or visual hallucinations involve the movement of objects around vision, but the visual surroundings themselves remain stationary and should not be considered vestibular vision symptoms
.
For example, seeing mobile vision such as "floaters" and migratory flashes of migraine visual aura often indicate damage
to the vestibular VOR pathway.
01
External vertigo External vertigo refers to the false sensationthat the visual surroundings are spinning or flowing.
Note: Symptoms of external vertigo include the illusion of continuous or intense visual flow on any spatial plane (e.
g.
, horizontal).
It differs from oscillation in that there is no bidirectional (oscillating) movement
.
External vertigo (visual movement) is usually accompanied by a feeling of internal vertigo (body movement).
However, even if there is no false feeling of nystagmus (internal vertigo), a violent nystagmus alone may cause a persistent sense of
visual flow.
02
Apparent oscillation refers to the false feelingthat a fixed object around it is perceived as motion.
It is manifested as difficulty reading the text
on the sign when walking.
This symptom occurs by vestibulo-ocular reflex abnormalities, commonly in vestibular, brainstem, or cerebellar lesions, and occasionally ophthalmoplegia or visual cortex lesions
.
The duration of visual oscillation is brief in unilateral peripheral acute vestibular injury, and the symptoms of visual oscillation may be persistent in central vestibular pathway lesions, often with other symptoms and signs
of brainstem damage.
Oscillations are most common in bilateral vestibular diseases, such as bilateral idiopathic vestibular disease, familial vestibular disease, and recurrent vestibular disease
.
03
Visual delay Visual delay is the false feeling that the surrounding scene lags behind the illusion of head movement, or that the surrounding scene has a brief movement after the head movementis completed.
This symptom is transient and usually lasts ≤ 1-2 seconds
.
It may be accompanied by ambulatory vertigo or dizziness
.
04
Visual tilt Visual tilt is the illusionthat the surrounding scene deviates from the vertical line.
This symptom is typically episodic and transient (lasting from a few seconds to a few minutes).
The so-called "room tilt illusion" (or "room inversion illusion") is often used to refer to a special tilt angle of 90◦ or 180◦, although the term visual tilt (with a specified approximate angle) is preferred
.
If the sensation of visual tilt is motor (i.
e.
angular change) and not fixed (i.
e.
, fixed angle), then it should be called external vertigo (visual sensation) or (internal) vertigo (physical sensation) instead of visual tilt
.
Also known as room tilt illusion, room inversion illusion, inverted vision
.
05
Movement-induced blurred vision refers to temporary loss of vision during or after head movement.
The vestibulo-ocular reflex contributes to the stabilization of retinal images during head movement, a dysfunction that can lead to retinal slippage, resulting in decreased
vision during or immediately after head movement.
This visual blurring may persist during sustained head movements (e.
g.
, during walking) or may be transient (e.
g.
, related to head motor vertigo or dizziness).
In these cases, some people experience visual oscillation or visual delay instead of blurred
vision.
4
Postural symptoms Postural symptoms are balance symptomsassociated with maintaining postural stability and occur only when
standing upright (sitting, standing, or walking).
In this nomenclature, "posture" refers to the symptoms of balance when standing upright (e.
g.
, standing), rather than the set of symptoms associated with changes in gravity due to changes in body posture (e.
g.
, standing up), which is called "orthodism.
"
Often suggests impaired
vestibulospinal reflex (VSR) pathway.
01
Instability refers to the feeling of instability while sitting, standing, or walking, without a specific orientation.
Note: Regardless of the upright posture (sitting, standing, or walking), increasing stability (e.
g.
, maintaining a stable surface, such as a wall) should significantly reduce or eliminate any instability; If not, the symptom should be considered to be vertigo or dizziness
.
Instability is a symptom that can occur in many other conditions than vestibular system disorders
.
If instability is present but there are no other vestibular symptoms, it is unlikely to be considered a vestibular system disease
.
02
Directional Dumping Directional dumping refers to the feelingof being unstable or deviating from a particular direction while sitting, standing, or walking.
The direction should be specified as sideways, forward, or backward
.
If the side is dumped, the direction (right or left)
should be specified.
Note: Regardless of the upright position (sitting, standing, or walking), increasing stability (e.
g.
, maintaining a stable surface, such as a wall) should significantly reduce or eliminate any directional rejection; If not, symptoms should be considered as dizziness or lightheadedness
.
03
Balance-related near-fall Balance-related near fall is a feeling of impending fall (without a complete fall) associated with intense instability, directional dumping, or other vestibular symptoms such as vertigo.A fall that is "caught" (e.
g.
, being extended to a wall by an outstretched arm) should be classified as close to a fall
.
Due to environmental disturbances (e.
g.
, "falls"), weakness (e.
g.
, fatigue, lower leg flexion), or near-loss of consciousness (e.
g.
, before syncope).
Resulting close falls should not be classified as balance-related
.
Near-falls are sometimes due to sudden changes in verticality perception (eg, visual tilt), a feeling of being pushed or pulled toward the ground, or a sudden loss of postural tone in the lower extremities associated with other vestibular symptoms
.
In neurootology, this is called "otolith crisis" or "stroke attack.
"
04
Balance-related falls Balance-related falls are complete falls associated with strong instability, directional dumping, or other vestibular symptoms such as vertigo.
Falls related to balance should not be classified as due to environmental disturbances (e.
g.
, "slippage"), weakness (e.
g.
, acute motor stroke), or loss of consciousness (e.
g.
, syncope, seizures, or coma
).
In neurootology, this is called "otolith crisis" or "stroke attack.
"
small
knot
The International Classification of Vestibular Symptoms has several important significances, first, it clarifies the definition and scope of vertigo and dizziness, emphasizing that vertigo and dizziness can coexist or appear sequentially, usually referred to as internal vertigo, different from external vertigoattributed to vestibular-visual symptoms.
Indicates that dizziness is not used to describe feelings of confusion, presyncope and syncope, weakness, lightheadedness, and detachment from reality, and the terms
non-specific dizziness and lightheadedness are no longer used.
Secondly, when studying vertigo/dizziness, it is necessary to pay attention to whether it is spontaneous or provoked seizures, further clarify the concepts of positionality and erectity, and abandon the concepts
of displacement and posture.
In addition, attention should be paid to vestibular-visual symptoms such as false sense of movement, visual tilt, and blurred vision due to vestibular function decline, which are often ignored clinically
.
It is also pointed out that terms such as fall attack and otolith crisis are no longer used, and are uniformly defined as balance-related near-falls and falls
.
Standardizing the understanding and application of vestibular symptomatic classification is a prerequisite
for vertigo work, clinical communication, and accurate and comprehensive medical history.
In order to better provide a diagnostic basis for clinical diagnosis and treatment and clarify the pathogenesis, in 2015, Barany Society published the International Classification of Vestibular Diseases, which we will learn more about
in the next issue.
References:
[1] Bisdorff A，Von B M，Lempert.
Classification of vestibular symptoms：towards an international classification of vestibular disorders.
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Journal of vestibular research：equilibrium and orientation，2009（1/2）：19.
[2] WU Ziming, ZHANG Suzhen.
International classification and analysis of vestibular symptoms[J].
Chinese Journal of Otology,2015,13(1):3.
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