Dizziness - Causes, symptoms and treatment. MF.
Apr 18, 2018
A sense of balance is an ancient acquisition of a person in the process of his evolution. A person in his daily life does not even ponder why he walks, runs, jumps, turns his head around and does not fall. The resulting imbalance leads to panic. The illusory movement of the environment or the patient itself, a sense of rotation, coups in the head, instability, unsteadiness, throws in the sides until the falls - this is called by the dizziness of .
Dizziness patients describe in different ways - swinging, swimming the head, rotation inside the head, instability, impaired coordination, weakness in the legs, unsteady walking, sensation of falling or rotation in the head. ..
Illusory movement of objects.
Causes of dizziness
The function of maintaining equilibrium depends on visual, vestibular, proprioceptive and surface-sensory information and is provided by a unique and very complex mechanism - the vestibular apparatus. All sensory information is processed in the central nervous system, modulated by the activity of the reticular formation, extrapyramidal system, cerebellum and cerebral cortex. Vestibular receptors determine the change in linear and angular acceleration and the change in the force of gravity, control the position of the head and translate this information into electrical impulses that the brain processes.
There is a vestibular apparatus in the stony part( pyramid) of the temporal bone. In its structure reminds something unrealistically fantastic - the bone labyrinth, consisting of three cavities: anterior bone snail;central( vestibule) with elliptical and spherical sac;posterior( vestibular chamber), in which in the upper and posterolateral direction there are gaps for semicircular canals;three bone semicircular canals. In the spherical and elliptical sacs, there is a small speck( less than 1 mm2) formed by a staticolite membrane made of a mucopolysaccharide gel with the inclusion of tiny crystals of calcium carbonate - statoliths. The position of the membrane depends on the magnitude and strength of the linear acceleration. Flask-like cells and cylindrical cells of the sensory epithelium of the system of semicircular canals have processes( hairs) - one thick long and up to 50 - 110 thin ones. With linear acceleration, the arch moves with the liquid and exerts an effect on the underlying sensory epithelium with hairs. Here, the mechanical forces( acceleration) are transferred to electrical activity( nerve impulse).This very complex mechanism depends on the direction of the current of the endolymph, the orientation of the hairs.
The mammary labyrinth is filled with perilymph, in which a communicating system of membranous sacs and membranous labyrinth is held by means of connective tissue strands. The membranous labyrinth is filled with endolymph. Liquids differ in their composition and never contact. Three semicircular canals( annular formations) lie in three mutually perpendicular planes, representing a three-dimensional space.
The vestibular apparatus is supplied with the internal auditory artery, the branch of the anterior cerebral and basilar arteries.
Vestibular nuclei are located in the lateral region of the brainstem and are supplied with blood from the vertebral and basilar arteries. This site is most susceptible to ischemic lesions. The outflow of blood goes to the upper bone sinus and sigmoid sinus.
The vestibular apparatus is innervated by the vestibular nerve.
Vestibular nuclei - a group of cells located at the bottom of the fourth ventricle - a diamond-shaped fovea. Four cores integrate information from labyrinths and other somatosensory systems. The nucleus is associated with the oculomotor nuclei, the motor part of the spinal cord, the cerebellum, the autonomic nervous system, the temporal lobes of the cortex of the cerebral hemispheres. From here comes the "answer" to motor neurons innervating the muscles of the eye( the position of the eyes is stabilized when the head moves), the organs involved in the regulation of the posture.
Under normal conditions, vestibular activity remains at a subconscious level, there is instantaneous "recognition" of changes in patterns of sensory influences. A person does not think about the position of the eyes when moving the head and tilting, jumping, walking and running to keep the balance. .. All this makes the vestibular apparatus instantly.
Any dysfunction of generation, integration, modulation in this stunningly complicated mechanism will cause dizziness, imbalance, and possibly nausea, vomiting.
Vertigo may be mild, transient, or may be an increasing and persistent symptom of a serious pathology. Causes of vertigo are the pathology of the vestibular part of the inner ear, damage to the connections with the vestibular nuclei in the trunk, the cerebellum, the medial longitudinal fascicle, the nuclei of the eye muscles, the muscles of the neck and the body, and the cortex of the brain.
Diseases accompanied by dizziness
Distinguish between systemic and non-systemic dizziness. Systemic dizziness occurs with the disease of the vestibular apparatus, it is felt as the movement of one's own body and objects. It can be accompanied by vegetative disorders, panic attacks, nystagmus, hearing loss. It is observed in Meniere's syndrome, viral and bacterial labyrinthitis, vestibular neuronitis, positional and post-traumatic dizziness. Non-systemic dizziness - sensation of "loss of consciousness", pre-obstruction, darkening before the eyes, fear, weakness, discomfort - with arterial hypo and hypertension, autonomic disorders, diseases of the cardiovascular and respiratory systems.
Dizziness occurs when:
- ear disease - acute or chronic inflammation of the middle ear( otitis);cholesteatoma;after operations on the mastoid process, on the inner ear with damage to the labyrinth;barotrauma;otosclerosis;toxic, infectious and traumatic labyrinthites;neurinoma of the auditory nerve;age degenerative processes of the vestibular labyrinth;
- cerebro-vascular diseases;
- infectious diseases, syphilis of the temporal bone;
- craniocerebral trauma, trauma of the temporal bone;
- diseases of the nervous system - multiple sclerosis, syringomyelia, Parkinson's disease, cerebellar diseases. ..;
- diseases of the cerebellum - degeneration, swelling;
- diseases of the cervical spine, Paget's disease( deforming ostosis) with damage to the temporal bone;
- intoxications - alcohol, industrial solvents, drugs, mercury, drugs;
- psychogenic disorders;
- somatic diseases - hypertension, atherosclerosis, rheumatism, ischemic heart disease, arrhythmias, stroke, anemia, oncological diseases, peptic ulcer, metabolic disorders. ..;
- mental illness.
Dizziness in the pathology of the spine is provoked by a circulatory disorder - vertebro-basilar insufficiency, disorders of the cervical sympathetic plexus, as a result of neck injury( whip-like), degenerative-dystrophic spinal processes, spondylolisthesis, congenital anomalies of the spine.
Mechanism of whiplash injury of the cervical spine .
Skeletal anomalies of the atlanto-occipital and cervical region are accompanied by dizziness, provoked by head turns, accompanied by pain in the neck, occiput, ringing in the ears, irritability.
Positional dizziness - dizziness in one position, when turning in bed, in a position on some side, tilting the head. This short-term dizziness, possibly accompanied by nausea, does not occur if the head is moved slowly. It is observed with head injuries, vascular pathology, pathology of the cervical spine, which can lead to circulatory inadequacy of the labyrinth through the vertebral arteries.
Vertigo is the most common symptom in a complex of pathological manifestations with vertebrobasilar insufficiency .This is periodic or persistent dizziness, spontaneous or provoked by movements of the head and neck, accompanied by falls, headache, decreased vision, doubling, numbness of the lips and tongue. Vertebrobasilar insufficiency occurs with atherosclerosis of carotid arteries, hypertension, discirculatory encephalopathy, pathology of vertebral arteries. Consequently, all these diseases have dizziness in their clinical picture.
Dizziness occurs in acute disorders of the cerebral circulation - stroke of ( ischemic and hemorrhagic), more often in the brainstem and cerebellum, subarachnoidal hemorrhages and can often remain a symptom of the consequences of the transferred brain accidents.
Dizziness with neurological diseases is never the only symptom and is combined with neurological symptoms - headache, noise, ringing, paresthesias and numbness of the face and limbs, nausea and vomiting, visual disturbances, paresis, paralysis, ataxia, loss of consciousness and objective neurologic symptoms,which the neurologist will see.
List of drugs with side effect - dizziness, is inexhaustible: analgesics, antianginal drugs, antihypertensives, beta blockers, diuretics, cardiac glycosides, antibiotics, nonsteroidal anti-inflammatory drugs, peptic ulcer drugs, antidepressants, anticonvulsants, tranquilizers,hypnotics, antiparkinsonics, hormones,. .. especially ototoxic aminoglycoside antibiotics - streptomycin, neomycin, kanamycin, gentamicin, tvraimicin. The defeat of the inner ear with aminoglycoside antibiotics can sometimes be difficult to treat. The imbalance in the use of vestibulotoxic drugs is usually transient and is restored after the drug is discontinued.
Diagnosis of vertigo
Since the list of disease states with dizziness is huge, the patient needs a comprehensive examination to determine the cause of vestibular disorders. First of all, consultation of otolaryngologist and neurologist doctors is required;therapist, oculist, infectious disease specialist, vascular surgeon, cardiologist - as needed. The ENT doctor examines the vestibular and auditory apparatus directly. The neurologist, in addition to the examination for the detection of specific neurological symptoms, may require x-rays of the cervical spine, temporal bone, dopplerography of the main vessels, computer and magnetic resonance imaging. Laboratory diagnosis is necessary - its volume depends on the individual condition of the patient and the physical illnesses found.
Dizziness against the background of a decrease in mental abilities, unreasonable pain, hypochondria and depression indicate the presence of a neurological or psychiatric cause of the disease. Dizziness is a symptom characteristic of a large number of diseases. Quite often the cause of dizziness remains unclear, even after a comprehensive clinical examination.
Treatment of dizziness
For symptomatic treatment of dizziness use preparations betagistina in a daily dosage of 48 mg( betaserk, vednorm);cardiovascular drugs to improve blood circulation - sermion, Cavinton, memoplant;vitamins of group B. The main thing is the treatment of the disease, the symptom of which was dizziness.
Prevention of dizziness
To prevent vestibular disorders, a healthy lifestyle, the exclusion of toxic substances, alcohol, nicotine, drugs, physical exercises, prevention of cerebrovascular diseases, timely access to a doctor and the necessary examinations and treatment recommendations is recommended. Massage, darsonvalization of the collar zone, reflexology, sanatorium treatment depending on the existing diseases is useful.
To which doctors to contact if dizziness occurs:
Consultation of otolaryngologist and neurologist doctors is required;therapist, oculist, infectious disease specialist, vascular surgeon, cardiologist - as needed.
Doctor neurologist Kobzeva S.V.