Dizziness, must be treated according to the disease

Dizziness, must be treated according to the disease

Vertigo is a disturbance of the body's sense of orientation or balance to spatial relationships, an illusion of movement of the self or the outside world that does not actually exist. Vertigo is divided into true vertigo and false vertigo.

True vertigo is caused by lesions of the vestibular nervous system. Patients feel that the surrounding objects are rotating in a certain direction, and they dare not open their eyes; they can also feel that they are turning, falling, ups and downs or shaking on a certain plane, accompanied by nausea and vomiting, complexion Pale, sweating, decreased pulse and blood pressure.

Pseudo-vertigo has no sense of the surrounding environment or self-rotation, only dizziness, light-headedness, shaking and even falling, usually not accompanied by nausea, vomiting and other symptoms, often caused by cardiovascular system diseases, systemic diseases and neurosis .

There are many vestibular and non-vestibular diseases that cause vertigo, and medication must be targeted according to the type of disease.

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Common disorders of peripheral vestibular vertigo

1. Meniere’s disease

Meniere's disease is a sudden onset of dizziness, deafness, tinnitus, and sometimes a non-labyrinthine lesion dominated by a feeling of fullness in the head and ear on the affected side, mostly in young adults. Its occurrence is related to allergies, endocrine disorders, vitamin deficiencies, mental and neurological factors, and autonomic dysfunction. The patient suddenly has a violent sense of rotation, and even wakes up from sleep, feels that the surrounding objects revolve around him, and even closes his eyes and feels his body flying in space; often grasps the edge of the bed, the armrest of the reclining chair or others, half-recumbent or supine, and feels dizzy when moving exacerbated. However, the patient was always conscious, accompanied by nausea and vomiting, pale complexion, cold sweats, hearing impairment, tinnitus, and a feeling of fullness in the ipsilateral head and ear.

Medication method: sedatives such as stability can be used to suppress symptoms and relieve pain. At the same time, vasodilators are used to eliminate inner ear microcirculation disorders, such as betadine or anisodamine. Dehydrating agents can be used to reduce labyrinthine hydrops and lower labyrinth pressure, such as hydrochlorothiazide. In addition, antiemetics can also be used to relieve nausea and vomiting, such as metoclopramide or domperidone.

2. Motion sickness

Or motion sickness, such as motion sickness, seasickness, airsickness, etc. It is due to the mechanical stimulation of the labyrinth of the inner ear when riding in a car, boat, plane, etc., causing vestibular dysfunction. It is mainly manifested as sudden onset of severe dizziness, nausea and vomiting, often accompanied by pale complexion, cold sweats, general weakness, etc.; those with weak constitutions are most susceptible to this disease. Lack of sleep, poor mood, bad smell stimulation, over-saturation or over-starvation, etc., are often the cause of this disease.

Medication method: Dimenhydrinate (also known as Chenghuoning, Halohaining, and Airsickness) can be used, 50-100 mg orally for adults, 12.5-25 mg for children 1-5 years old, and the same for adults over 6 years old. Take it 30 minutes before traveling by car, boat, or plane. Or use diphenhydramine, 25 to 50 mg each time for adults and 2 to 4 mg per kilogram of body weight per day for children (same usage as before). Or use a halo sticker (also called motion sickness sticker, ride halo sticker, etc.), and stick it on the navel 30 minutes before each car, boat, or plane ride (there are also behind-the-ear dosage forms). Oral metoclopramide (or domperidone) can also be given to relieve nausea and vomiting.

3. Vestibular neuronitis

Also known as epidemic vertigo, epidemic labyrinthitis, etc., the symptoms are acute onset of vertigo, no tinnitus, deafness, more common in young people, often have a history of viral cold before the attack. A small number of patients have a prodromal period of light-headedness or walking and standing unsteady for hours or days before the onset of vertigo, with severe vertigo, nausea, vomiting, and inability to move. Severe symptoms may disappear within a few days, but mild cases may last for several weeks, and a few people may have recurrent attacks.

Medication method: In order to control the course of the disease, when the above typical symptoms appear, antiviral treatment should be given for 3 days. Oral solution. Eliminate dizziness, nausea and vomiting symptoms as before.

Common diseases of central vestibular vertigo

1. Vertebral-basilar insufficiency of blood supply

It is caused by ischemic attack of vertebral-basilar artery and brainstem infarction in the supply area. Patients over 50 years old with hypertension and arteriosclerosis suddenly appear dizzy, and this disease should be considered first. Symptoms are rotational and swinging vertigo, may have unsteady standing, a sense of ground movement, and are often accompanied by diplopia, balance disturbance, and numbness. Another type of dumping paroxysmal vertigo is caused by ischemia in the pyramidal junction area and transient loss of limb muscle tone, manifested as a fall when standing or walking, without disturbance of consciousness. If the attack lasts for a few minutes, hours or even returns to normal within 24 hours, it is called a transient ischemic attack, and you should go to the hospital in time.

Medication method: vasodilator drugs can be used to increase blood supply to the neck and brain, such as compound Danshen tablets, cinnarizine, etc. In order to prevent the course of the disease from developing into a transient ischemic attack, antiplatelet aggregating drugs such as aspirin, ticlopidine, and clopidogrel can be used. At the same time, lipid-lowering therapy should also be performed, and statins such as atorvastatin can be used. If the above treatment effect is not obvious, you should go to the hospital in time.

2. Lateral medullary syndrome

The posterior inferior cerebellar branch of the vertebral artery supplies blood to the cerebral medulla. If it is occluded or narrowed, the blood supply will be insufficient, causing severe dizziness, balance disturbance, nausea and vomiting, slurred speech, and choking on eating; nystagmus, vocal cords, etc. are also seen. Paralysis, and decreased or absent pain and temperature sensation on one or both sides of the face and symmetrical limbs. The onset of the disease is rapid, and the patients are older (mostly over 50 years old).

Medication method: refer to vertebral-basilar artery insufficiency.

Common disorders of non-vestibular systemic vertigo

1. Traumatic vertigo

sequelae of traumatic brain injury. Symptoms are mainly dizziness. Patients often complain of a sense of movement in themselves or the surrounding environment. At the same time, they feel unstable when standing, sitting, or lying down. When doing movements such as turning or looking up, the above symptoms can be aggravated.

Medication method: available nutritional cranial nerve drugs such as vitamin B1, while taking vitamin B6. At the same time, drugs that promote brain cell recovery, such as Naofukang, and drugs that adjust autonomic nerves, such as oryzanol, can also be taken orally. Generally, they need to be taken continuously for more than 3 months.

2. Cervical vertigo

Cervical spondylosis (such as cervical vertebra hyperplasia, cervical spondylosis, intervertebral disc herniation, etc.), cervical myopathy (such as cervical muscle strain, etc.) Insufficient blood supply to the vestibular nucleus area, or neck lesions that stimulate the sympathetic nerves around the neck and arteries. Symptoms are sudden instability, rocking, and rotational dizziness when the head is suddenly turned or in a certain position, lasting several seconds to several minutes, and may be accompanied by nausea and vomiting.

Medication method: Patients with cervical vertebra hyperplasia can take orally treat cervical spondylosis drugs, and patients with cervical vertebra loose can supplement calcium, and at the same time apply drugs that promote calcium bone absorption, such as calcitonin, until symptoms disappear, X-ray examination of osteoporosis recovery normal. Such as vertigo caused by intervertebral disc herniation, should go to the hospital for treatment.

3. Psychogenic vertigo

Most of them are caused by functional heart disease (such as cardiac neurosis) resulting in arrhythmia, decreased cardiac output, and insufficient blood supply to the brain. Psychogenic vertigo is more common in adolescents or young women. The symptoms are gradual onset and may be accompanied by anxiety symptoms (such as sighing, silent tears, insomnia, irregular menstruation, etc.), sudden onset and sudden termination. On this basis, arrhythmia (such as bradycardia, tachycardia, premature beat, etc.) occurs, and the electrocardiogram may be abnormal.

Medication method: You can choose to adjust autonomic function drugs such as oryzanol, and vitamin drugs (such as vitamin B1 and B6, the same as before). If tachycardia, bradycardia, or premature beats occur, medication may be used as appropriate. For tachycardia, propranolol can be added (for those with asthma, it is forbidden); for bradycardia, atropine can be added; for those with premature beats, amiodarone hydrochloride can be added at the same time; for insomnia, diazepam or luminal can be used (same usage as above); Such as with irregular menstruation should go to gynecological treatment.

4. Dizziness due to autonomic dysfunction

It is another common functional vertigo other than psychogenic vertigo. Symptoms are more common in young and middle-aged women, with sudden onset, severe dizziness, nausea, vomiting, pale complexion, and often lasts for several hours to several days. The above symptoms of neurosis can be induced by overwork and mental factors.

Medication method: refer to psychogenic vertigo.

Text / Chen Jinwei

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