Vertigo

Vertigo is the most common clinical syndrome. With the aging of the population, the incidence of this disease is increasing day by day, and it has received widespread attention from the medical community at home and abroad. Smith (1993) reported that vertigo is the third most common symptom in outpatient clinics. It involves multiple disciplines and the vast majority of people experience it at some point in their lives. According to statistics, vertigo accounts for 5% of internal medicine outpatients and 15% of otolaryngology outpatients. 50-60% of the elderly living at home have vertigo, accounting for 81-91% of geriatric outpatient visits; among them, the incidence of vertigo in elderly people over 65 years old accounts for 57% of women and 39% of men.

What is vertigo?

Vertigo is a general term for dizziness and dizziness, which is characterized by vertigo, blurred vision and darkness; vertigo is characterized by spinning vision, or being unable to stand as if the world is spinning. Dizziness, because the two are often seen at the same time, it is called vertigo.

Classification of vertigo: true vertigo, pseudovertigo

1. True vertigo

Refers to the disease caused by eye, proprioception or vestibular system, with Obvious sense of rotation of foreign objects or self. Depending on the damaged part, it can be divided into ocular, proprioceptive and vestibular vertigo.

Most symptoms of vertigo caused by vestibular system diseases are severe, such as Meniere's syndrome, vertebrobasilar artery insufficiency, brainstem infarction, etc., and often recur.

Ocular vertigo can be a physiological phenomenon or pathological. For example, if you stare at the scenery outside the window for a long time on a train, you may experience dizziness and railway nystagmus; if you look down at the rushing water under your feet on a high bridge, you may feel yourself moving in the opposite direction and become dizzy. These are physiological dizziness induced by visual and optokinetic stimulation, and the symptoms will disappear when removed from the environment. Eye diseases such as acute ophthalmoplegia can cause double vision and vertigo.

Vertigo caused by proprioceptive impairment is called postural vertigo, which is seen in patients with syringomyelia and syphilis due to deep sensory impairment and movement disorders.

2. Pseudovertigo

Refers to vertigo caused by systemic diseases, such as cardiovascular disease, cerebrovascular disease, anemia, uremia, drug poisoning, endocrine diseases and Neurosis, etc., almost all have dizziness symptoms ranging in severity. Patients feel "drifting" without a clear sense of rotation.

Medical history and clinical symptoms and signs

1. Situation before the onset of vertigo

Whether there were factors such as excessive smoking and drinking, mental and emotional instability, fatigue and insomnia before the onset of vertigo .

2. Vertigo attacks

(1) Is the onset at night or in the morning, sudden onset or slow onset?

(2) First onset or recurring onset;

(3) Under what circumstances does the onset occur, such as body position change, neck twisting, or a special position;

(4) Is the form of vertigo rotational or non-rotational;

(5) Whether the intensity can be tolerated and whether the consciousness is clear;

(6) Whether the vertigo is relieved or aggravated when the eyes are opened or closed, and whether the vertigo is aggravated by sound and light stimulation and changing body positions. .

3. Symptoms associated with vertigo

(1) Autonomic symptoms: blood pressure changes, sweating, pale complexion, diarrhea;

(2) Ears Symptoms: deafness, tinnitus, ear tightness;

(3) Eye symptoms: blackness in front of the eyes, double vision, blurred vision;

(4) Neck symptoms: neck Or pain in the shoulders and arms, numbness of the upper limbs, and limited movement;

(5) Central nervous system symptoms: headache, disturbance of consciousness, sensorimotor disorder, language or articulation disorder, etc.

What tests should be done for dizziness?

Vestibular function test:

(1) Vestibular function test in the clinic or at the bedside: including upright dumping test, standing step test, neck twisting test, etc.;

(2) Nystagmus

(3) Electronystagmogram

(4) Balance posture chart

Auditory function test:

Imaging examination: Head CT, MRI, etc. to determine whether there is head space-occupying, ischemic or hemorrhagic disease.

Other medical examinations: including blood pressure, electrocardiogram, biochemical examination, etc.

Various common systemic diseases associated with vertigo

1. Cerebrovascular vertigo: sudden onset of severe rotational vertigo, which may be accompanied by nausea and vomiting, and gradually lessens after 10-20 days. Often accompanied by tinnitus and deafness, but with clear consciousness.

2. Brain tumor vertigo: Mild vertigo often occurs in the early stage, which can present a sense of swinging and instability, while rotational vertigo is rare and often presents with symptoms such as unilateral tinnitus and deafness. As the disease progresses, Signs of damage to adjacent cranial nerves may appear, such as facial numbness and hypoesthesia on the affected side, peripheral facial paralysis, etc.

3. Cervicogenic vertigo: manifests as various forms of vertigo, accompanied by dizziness, shaking, unsteady standing, and a sense of heaving and floating. Vertigo occurs repeatedly, and its occurrence is obviously related to sudden head rotation, that is, it often occurs during neck movement, and sometimes presents with deformational vertigo when sitting up or lying down. Generally, the onset is short-lived, ranging from seconds to minutes, and there are also cases that last longer. Neck or occipital pain may occur when you wake up in the morning. Some patients may experience cervical nerve root compression symptoms, that is, numbness and weakness in their arms, and involuntary falling of objects.

More than half of the patients are accompanied by tinnitus, and 62-84% of patients have headaches, mostly localized in the parietal and occipital regions, often with paroxysmal throbbing pain.

4. Ophthalmogenic vertigo: non-motion illusion vertigo, mainly characterized by a sense of instability, which is aggravated by excessive eye use and relieved by closing the eyes and resting. The dizziness lasts for a short time, worsens when you open your eyes to look at external moving objects, and relieves or disappears after closing your eyes. Often accompanied by blurred vision, vision loss or double vision. There are often abnormalities in visual acuity, fundus, and eye muscle function tests, but there are no abnormalities in the nervous system.

5. Cardiovascular vertigo: Dizziness caused by hypertension can be clearly diagnosed through blood pressure measurement. Carotid sinus syndrome can cause episodes of vertigo or syncope. Most of the triggers are factors that suddenly cause pressure on the carotid artery, such as turning the neck sharply, lowering the head, or wearing a too tight collar.

6. Endocrine dizziness: Hypoglycemic dizziness often attacks when hungry or before eating, lasting from tens of minutes to an hour. Symptoms are relieved or disappear after eating, and are often accompanied by fatigue. Check blood sugar during the attack. Hypoglycemia may be found. Thyroid dysfunction can also cause dizziness. Clinically, it is mainly balance disorder, and related examinations of thyroid function can confirm the diagnosis.

7. Dizziness caused by blood diseases: Leukemia, pernicious anemia, hypercoagulable diseases, etc. can cause dizziness, and the diagnosis can be confirmed through blood system examination.

8. Neurological vertigo: Patient symptoms are diverse. Dizziness is mostly pseudo-vertigo, often accompanied by headache, dizziness, heaviness, or insomnia, palpitations, tinnitus, anxiety, and polysomnia. Various neurotic symptoms such as dreams, inattention, memory loss, etc., without any sense of rotation of foreign objects or rotation or shaking of oneself. For women over 45 years old, attention should also be paid to the identification of menopausal syndrome.

Prevention and treatment of vertigo

Patients with vertigo should be accompanied by family members when going out to prevent accidents.

1. Cerebrovascular vertigo: Due to the increase in blood viscosity in summer and winter, various cerebrovascular accidents are prone to occur, leading to the occurrence of cerebrovascular vertigo. You should drink plenty of water and avoid sudden changes in body position. For example, standing up when going to the toilet at night can easily cause cerebrovascular vertigo. Once it occurs, you should go to the hospital as soon as possible. After diagnosis, vasodilator drugs, anti-platelet aggregation drugs (such as aspirin), anticoagulant drugs, etc. can be appropriately given.

2. Brain tumor vertigo: This type of vertigo usually develops slowly, with mild initial symptoms and difficult to detect. For mild vertigo that gradually appears, if it is accompanied by symptoms such as unilateral tinnitus and deafness, or other signs of damage to adjacent cranial nerves, such as facial numbness and hypoaesthesia on the affected side, peripheral facial paralysis, etc., you should go to the hospital for diagnosis and treatment as soon as possible to clarify Diagnosis, early surgical treatment.

3. Cervicogenic vertigo: Pay attention to your usual working and studying posture, and move your neck appropriately after working at the desk for a long time. The height of the pillow should be appropriate, and the pillow should not be too high to cause cervicogenic vertigo. Rehabilitation methods are often used for treatment, such as cervical vertebra and jaw pillow sling traction, massage therapy, acupuncture, etc. Severe cases require surgical treatment.

4. For dizziness caused by other diseases, such as endocrine vertigo, hypertensive vertigo, and ophthalmogenic vertigo, the primary disease should be actively treated, such as controlling blood pressure and treating ophthalmic diseases. After the primary disease has recovered, Basically, dizziness can be relieved naturally.

5. Neurological vertigo: For vertigo caused by mental factors, the patient’s anxiety should first be relieved, and anti-anxiety or antidepressant drugs can be given appropriately, but long-term use of sedative drugs should be avoided. , so as not to increase drug tolerance and dependence.

Conclusion

The clinical manifestations of vertigo are complex and diverse, involving multiple disciplines and dozens of diseases. Patients should actively prevent and control the primary disease; once symptoms appear, they should go to the hospital for diagnosis and treatment as soon as possible to avoid delaying the condition.

Dizziness, often called lightheadedness, is a common symptom. In mild cases, the attack is short-lived, and the patient can return to normal after lying down with his eyes closed for a while; in severe cases, the patient feels like he is riding in a car or boat, feeling like the world is spinning, and even standing unsteadily. The condition of most patients is mild and severe, and other symptoms are present and last for a long time. It is more common in diseases such as hypertension, arteriosclerosis, anemia, neurosis, and otogenic vertigo.

Shoudu massage has certain curative effect in treating vertigo. However, patients must cooperate with the doctor to identify the cause and actively treat the original disease. Hand massage can be used as an auxiliary method in comprehensive treatment. Clinical treatment shows that hand massage combined with traditional Chinese medicine and other methods are effective in treating inner ear vertigo, labyrinthitis, motion sickness, basilar artery insufficiency and vertigo caused by systemic diseases.

[Massage point selection]

Meridian points: Neiguan, Yanggu, Zhizheng, etc.

Reflex areas: pituitary gland, cerebellum and brainstem, brain, neck, inner ear labyrinth, ears, eyes, liver, kidney, adrenal gland, thyroid, spleen, etc.

Reaction points: heart points, etc.

Holographic points: head points, etc.

[Massage method]

Press and knead or pinch Neiguan 200 times, Yang Gu and Zhizheng 50 times each; click on the pituitary gland, cerebellum and brain. Brain, inner ear, labyrinth, ears, eyes, liver, kidneys 200 times each, adrenal gland, thyroid, spleen. 100 times each on the neck; rub the heart point 300 times and pinch the joint points 500 times. Massage once a day, one course of treatment is one month, and can last for 3-4 courses according to the treatment situation.

Patients with vertigo should pay attention to their diet and daily life, regulate cold temperature, and avoid excessive fatigue; measure their blood pressure regularly, stop smoking and drinking, be cautious in sexual intercourse, maintain emotional stability, and avoid mental stimulation. When vertigo occurs, you should lie down with your eyes closed, keep the environment quiet, and eat light meals, small and frequent meals. If vertigo occurs repeatedly, it is not advisable to work at heights or on water. If patients with high blood pressure suddenly experience dizziness, they should consider the signs of stroke

Difenidol acid

Pharmacology:

Pharmacodynamics

This product can improve the insufficiency of the blood supply of the vertebral artery, regulate the vestibular nervous system, treat various central and peripheral vertigos, have anti-emetic and inhibit nystagmus effects, and can resist motion sickness. This product also has a weak peripheral anti-M-choline effect.

Pharmacokinetics

This product is absorbed through the gastrointestinal tract, and the blood concentration reaches its peak 1.5 to 3 hours after taking the medicine. The half-life is 4 hours. Excreted unchanged in urine.

[Pharmacological effects] This product has a dilation effect on spasmed blood vessels and can increase the blood flow of cerebral arteries, especially the blood flow of basilar arteries. In addition, this product can adjust abnormal impulses of the vestibular nerve, inhibit the vomiting center and improve nystagmus, so it can be used for patients with dizziness and vomiting. This product has no antihistamine effect, no sedative effect, and no anesthesia-enhancing effect.

Pharmacokinetics

This product is absorbed from the gastrointestinal tract after oral administration. The peak blood concentration time is 1.5 to 3 hours, and the metabolites are excreted in the urine.

Indications:

Used for dizziness and vomiting caused by various diseases (such as vertebral artery insufficiency, Meniere's disease, autonomic nerve dysfunction, hypertension, hypotension , cervical vertigo, trauma or drug poisoning), vomiting after surgical anesthesia; it has a preventive and therapeutic effect on motion sickness.

This product is used to treat vertigo caused by various causes, such as vertebrobasilar artery insufficiency, Meniere's disease, autonomic nerve dysfunction, cervical vertigo and motion sickness, etc. According to clinical efficacy observation, its effective rate is above 80%. The advantage of this product is that it has high efficacy without any adverse reactions such as drowsiness or excessive excitement, and has no impact on the normal work of personnel. It can be used as the main drug for the treatment of vertigo.

Usage and dosage:

Usual oral dosage for adults, 25-50 mg once, 3 times a day.

[Preparation and specifications] Difenidol hydrochloride tablets 25 mg

Orally administered, 25-50 mg once, 3 times a day.

[Usage and dosage] Take orally, 25 to 50 mg each time, 3 times a day. Intramuscular injection, 10 to 20 mg each time, 1 to 2 times a day.

[Dosage form and specification] Tablet: 25mg/tablet. Injection: 10mg/ml.

Disabled use with caution:

Because this product has a mild anti-M-choline effect, it is used for glaucoma, gastrointestinal or urinary tract obstructive diseases, and tachycardia. Caution is required and it is contraindicated in patients with renal insufficiency.

Patients with glaucoma should use with caution, and those with severe renal impairment and allergies should avoid use.

Adverse reactions:

Mainly include dry mouth and mild gastrointestinal discomfort, which will disappear after stopping the drug. In addition, there are reports of auditory hallucinations, visual hallucinations, disorientation, confusion, drowsiness, restlessness, depression and anti-M-cholinergic effects. Occasionally, transient hypotension, headache and rash may be seen.

The main symptoms are dry mouth and stomach discomfort. A few patients have tinnitus, drug rash, coldness in the hands and feet, loss of appetite, drowsiness, palpitations, etc. The overall incidence of various side effects is approximately 10%. The occurrence of the above side effects does not affect the continued treatment. -Generally disappears after discontinuation of medication.

Interactions:

Taking diphenidol first can reduce the emetic effect of apomorphine in the treatment of poisoning.

Combined use of this product with other drugs that increase blood supply to the brain can enhance its anti-vertigo effect.

Patients with vertigo should pay attention to a balance between work and rest, avoid fatigue, maintain adequate sleep, and avoid mood swings. Anxiety, anger, nervousness, fear, anxiety, etc. may all cause dizziness. During an attack of vertigo, pay attention to eating light and not drinking alcohol. During an attack of vertigo, you must stay in bed and do not move your head from side to side.