Dizziness — feeling of imaginary rotation and/or progress of the patient in various planes, is more rare — illusion of shift of the motionless environment in any plane. In clinical practice the term "dizziness" is treated much more widely therefore includes the states and feelings caused by violations of receipt of touch information (visual, propriotseptivny, vestibular, etc.), its processings. The main display of dizziness — difficulty of orientation in space. Dizziness can have the most various reasons. The problem of diagnostics consists in identification of an etiology of dizziness that allows to decide further on the most effective tactics of its treatment.
Dizziness — feeling of imaginary rotation and/or progress of the patient in various planes, is more rare — illusion of shift of the motionless environment in any plane. In clinical practice the term "dizziness" is treated much more widely therefore includes the states and feelings caused by violations of receipt of touch information (visual, propriotseptivny, vestibular, etc.), its processings. The main display of dizziness — difficulty of orientation in space.
Etiology and pathogenesis of dizzinesses
Ensuring balance is possible at integration of activity of the vestibular, propriotseptivny, visual and tactile systems which are closely connected with bark of big hemispheres and subcrustal educations. The histamine influencing histamine receptors plays an important role in information transfer from receptors of polukruzhny channels. Holinergichesky transfer makes the modulating impact on gistaminergichesky neurotransmission. Thanks to acetylcholine perhaps information transfer from receptors to lateral vestibular kernels and the central departments of the vestibular analyzer. It is proved that vestibulovegetativny reflexes function thanks to interaction holin-and gistaminergichesky systems, and a histamine - and glutamatergichesky ways provide a vestibular afferentation in a medial kernel.
Classification of dizzinesses
Allocate system (vestibular) and not system dizziness. Carry psychogenic dizziness to not system dizziness, preunconscious states, balance violations. The use of the term "physiological dizziness" is in certain cases possible. Physiological dizziness is caused by excessive irritation of a vestibular mechanism and occurs owing to long rotation, sharp change of speed of the movement, observation of moving objects. Is a part of a syndrome of a motion sickness.
System dizziness pathogenetic is connected with direct defeat of the vestibular analyzer. Depending on the level of its defeat allocate the central or peripheral system dizziness. Central it is caused by defeat of polukruzhny channels, vestibular and nerves, peripheral — defeat of vestibular kernels of a brain trunk and a cerebellum. Within system dizziness allocate: propriotseptivny (feeling of the passive movement of own body in space) and tactile or tactile (feeling of rocking on waves, a pripodnimaniye or fall of a body, unsteadiness of the soil, a moving support under legs).
Not system dizziness is characterized by feeling of instability, difficulties at maintenance of a certain pose. In its basis the mismatch of activity of vestibular, propriotseptivny, visual sensitivity occurring at various levels of nervous system.
Clinical picture of dizzinesses
- System dizziness
System dizziness is observed at 35-50% of patients with complaints to feeling of dizziness. Developing of system dizziness is often caused by defeat of peripheral department of the vestibular analyzer because of toxic, degenerate and traumatic processes, is much more rare — sharp ischemia of these educations. Defeat of the structures of a brain located above (subcrustal structures, a brain trunk, bark of big hemispheres and white substance of a brain) most often happens in connection with vascular pathology, degenerate and traumatic diseases. The most frequent reasons of system dizziness — vestibular neyronit, Menyer's disease, benign paroksizmalny position dizziness, a nevrinom of the VIII couple of ChN. Adequate assessment of the anamnesis and results of clinical inspection is necessary for definition of nature of a disease already at the first survey of the patient.
The Benign Paroksizmalny Position Dizziness (BPPD) — the most frequent reason of system dizziness. In its basis — education in a cavity of polukruzhny channels of the units of a carbonate of calcium rendering irritant action on receptors of a vestibular mechanism. The episodes of intensive dizziness (at change of position of the head) which are followed by nausea, bradycardia and other vegetative frustration are characteristic of DPPG short-term (up to 1 minute). One of distinctive signs of DPPG is absence during noise dizziness episodes in ears, focal neurologic deficiency.
Vestibular neyronit is characterized by dizziness attacks lasting from several hours up to several days. Arises sharply, often after the postponed bacterial or viral infection. The patient tests very intensive dizziness which is followed by the expressed vegetative frustration. There are no meningealny and focal neurologic symptoms. Hearing is kept.
Post-traumatic dizziness arises right after a craniocereberal trauma. At the same time existence of focal symptoms of damage of a brain is not obligatory. Post-traumatic dizziness can arise and after a while (4-5 days) after a head injury that can be connected with formation of a serous labyrinth.
Toxic damage of a vestibular mechanism — the progressing system dizziness in combination with violations of coordination of the movement connected with application of aminoglycosides which are capable to collect in endo-and a perilimfa.
Menyer's disease — repeated attacks of the intensive system dizziness which is followed by noise and a ring in ears we flyuktuiruyushchitsya by decrease in hearing and the expressed vegetative frustration. In its basis — increase in volume of the endolymph causing stretching of walls of channels of a labyrinth. Duration of attacks of dizziness — of several minutes till 24 o'clock, frequency — from several times a day to 1 time a year. The attack is followed by the expressed violations of balance and vegetative frustration which can remain also after the termination of an attack within several days. In process of progressing of a disease hearing decreases (as a rule, unilaterally), however total loss of hearing does not happen.
Temporal epilepsy — the repeated unprovoked episodes of system dizziness which are followed by the expressed vegetative violations (nausea, pain in epigastralny area, bradycardia, , feeling of heat). Besides, at a clinical picture there can also be visual disorders and other disorders of perception.
- Not system dizziness
Violation of balance can be caused by dysfunction of the vestibular analyzer of various genesis. One of the major distinctive signs — deterioration in a condition of the patient at sight control loss (the closed eyes). Multitouch deficiency, and also use of some medicines (derivatives of a fenotiazin, benzodiazepines) can be other causes of infringement of balance damage of a cerebellum, subcrustal kernels, a brain trunk. In such cases dizziness is followed by violation of the concentration of attention increased by drowsiness (gipersomniy). Expressiveness of these manifestations decreases at decrease in a dose of medicine.
Preunconscious states — feeling of dizziness, a ring in ears, "darkenings in eyes", faintness, balance loss. Psychogenic dizziness belongs to the most frequent symptoms of the panic attacks and is among the most frequent complaints which are shown by the patients suffering from psychogenic frustration (hysteria, an ipokhondrichesky syndrome, a neurasthenia, depressions). Differs in firmness and the expressed emotional coloring.
Diagnosis and differential diagnosis
For diagnosis of dizziness the neurologist needs to confirm first of all the fact of dizziness as patients quite often put other sense in the concept "dizziness" (a headache, violation of clearness of sight, etc.). For this purpose in the course of differential diagnostics between dizziness and complaints of other character, it is not necessary to prompt to the patient this or that term or to offer them at choice. It is much more correct to hear from it the detailed description of the available complaints and feelings.
Much attention should be paid to neurologic survey of the patient (a condition of ChN, identification of a nistagm, koordinatorny tests, detection of neurologic deficiency). However even full inspection not always allows to define the diagnosis, for this purpose observation of the patient in dynamics. In such cases information on intoxications postponed earlier, autoimmune and inflammatory diseases can be useful. Consultation of an otonevrolog, vestibulolog and inspection of cervical department of a backbone can be necessary for the patient with dizziness: X-ray analysis, backbone KT, MPT.
By means of KT and MPT of a brain it is necessary to exclude new growths, demiyeliniziruyushchy process and other structural changes of the congenital and acquired character. Definition of antibodies to estimated activators, and also a full-fledged research of cellular composition of blood is capable to confirm or disprove existence of infectious diseases. In favor of the diagnosis "Meyer's disease" specifies improvement of perception of low frequencies at registration of an audiogramma. It is necessary to remember also EEG of a brain allowing to exclude epileptic and paroksizmalny activity in temporal assignments. Conduct also a research of the vestibular analyzer: vestibulometriya, stabilografiya, rotary tests, etc.
Treatment of dizzinesses
The choice of tactics of treatment of dizziness is based on a cause of illness and mechanisms of its development. Anyway therapy has to be directed to disposal of the patient of unpleasant feelings and the accompanying neurologic frustration. Therapy of disorders of brain blood circulation means control of arterial pressure, purpose of antiagregant, nootrop, venotonik, vazodilatator and in case of need — antiepileptic medicines. Treatment of a disease of Menyer assumes purpose of diuretics, restriction of reception of table salt, and in lack of due effect and the proceeding attacks of dizziness resolve an issue of surgical intervention. At treatment of a vestibular neyronit use of antiviral medicines can demand. As at DPPG use of the medicines oppressing activity of the vestibular analyzer is considered inexpedient, the main method of treatment of benign paroksizmalny position dizziness — reception of a repozitsionirovaniye of the units irritating the vestibular analyzer on J.M. Epley.
As symptomatic treatment of dizziness apply vestibulolitik (). Efficiency of antihistamines (, ) in case of primary defeat of the vestibular analyzer is proved. In treatment of not system dizzinesses non-drug therapy is of great importance. With its help restoration of coordination of movements and improvement of gait is possible. Therapy of psychogenic dizzinesses it is expedient to carry out together with the psychotherapist (psychiatrist) as purpose of anksiolitik, antidepressants and antikonvulsant in certain cases can be required.
The forecast at dizziness
It is known that the dizziness attack often is followed by sensation of fear, however dizziness as a state, is not life-threatening. Therefore in case of timely diagnosing of the disease which caused dizziness and also its adequate therapy in the majority a case the forecast favorable.