Two different dizzinesses, which are called in one word
The division into two types is not an academic subtlety, but a basic diagnostic tool. Where to go and what to examine depends on which group the sensation belongs to, and a mistake here costs months of useless treatment.
The first type is systemic, or vestibular vertigo. This is an illusion of movement: it appears that the room is spinning, tilting or floating, or that the person himself is spinning. It is often accompanied by nausea, vomiting, sweating, involuntary twitching of the eyes and clearly intensifies with head movements. The cause is in the vestibular system - in the inner ear or in the parts of the brain associated with it. The second type is non-systemic dizziness and a pre-fainting state: darkening in the eyes, roaring in the ears, weakness, a feeling of impending fainting, “the floor is going away.” There is no rotation. The cause is usually outside the ear: low blood pressure, abnormal heart rhythm, low hemoglobin, low sugar, dehydration, medication side effect, anxiety disorder.
- Ask yourself: is the room moving around you or are you just feeling groggy and groggy? This is the main question that the doctor will ask
- Rotation with nausea and worsening when turning the head - vestibular cause
- Darkening in the eyes when standing up, weakness, perspiration, ringing in the ears - presyncope
- A feeling of unsteadiness and unsteadiness when walking without rotating - most often a problem with balance, vision or nerves in the legs
- A constant feeling of brain fog and disconnection from what is happening, aggravated in stores and crowds, is often associated with anxiety
- Mixed options do occur, and it’s up to the doctor to sort them out, not the search string.
BPPV: pebbles in the ear and treatment without drugs
Benign paroxysmal positional vertigo is the most common cause of true rotation and is something everyone should know about. In the inner ear there are structures containing tiny crystals of calcium carbonate, which are normally in place and are involved in determining the position of the head. Sometimes these crystals break off and end up in the semicircular canals, the fluid-filled tubes responsible for sensing rotation. When the position of the head changes, the crystals move, causing the liquid to move, and the brain receives a false signal about a sharp rotation, although the person lies motionless.
- The attack occurs strictly when changing position: turned over in bed, lay down, stood up, threw back his head to the top shelf, bent over to tie his shoelaces
- It lasts seconds, usually from 10 to 60, and goes away on its own if you freeze
- Between attacks the person feels normal, although there may remain slight uncertainty and fear of turning around
- Hearing does not decrease, there is no noise in the ear - this is an important difference from other diseases of the inner ear
- Often begins after sleep, when first turning on its side, and the person wakes up with the feeling that the bed is turning over
- More common after 50 years of age, in women, as well as after head injuries, prolonged bed rest and dental procedures with the head thrown back
And here is the most valuable thing. BPPV is diagnosed at an appointment using positional tests: the doctor positions the person in a certain way and observes the characteristic eye twitching, which occurs with a short delay and quickly wears off. Then a healing maneuver is performed - a series of precise, sequential rotations of the head and body that move the crystals back out of the channel to where they do not cause false signals. The effectiveness is high: in most patients the problem is eliminated in one to three sessions. No medications are required for this, and this is the main paradox of the situation - the most common cause of dizziness is treated literally with the hands of a doctor in a few minutes, but people have been receiving vascular drips for years.
Other vestibular causes
If the rotation lasts hours or days rather than seconds, BPPV is unlikely and the search circle changes. The key feature for differentiation is the duration of the attack and the presence of auditory symptoms.
- Vestibular neuronitis is inflammation of the vestibular nerve, most often after a viral infection. Severe rotation with nausea and vomiting lasts from a day to several days, but hearing is not affected; then the condition gradually improves over weeks
- Meniere's disease - attacks of rotation lasting from 20 minutes to several hours, accompanied by hearing loss, noise and a feeling of fullness in the ear; Over time, hearing may deteriorate permanently
- Vestibular migraine - attacks of dizziness in people with migraine, lasting from minutes to days, often without headache at this moment, but with photophobia and noise intolerance; cause is underestimated and often missed
- Labyrinthitis - inflammation of the inner ear, usually associated with otitis, with rotation and hearing loss
- Bilateral vestibulopathy - persistent instability and blurred vision when walking, often after taking certain medications
- Tumor of the auditory nerve is a rare cause in which gradual unilateral hearing loss and tinnitus, rather than attacks of rotation, come to the fore
Persistent postural-perceptual dizziness deserves special mention - a condition in which, after an acute episode, a person is left with a persistent feeling of instability and swaying, lasting for months. It intensifies in a vertical position, when moving, in supermarkets, on an escalator, when working with a screen. This is not “residual effects that must be endured” or fiction: the mechanism is due to the fact that the brain, after a fright, consolidates a mode of increased balance control. It is treated with vestibular rehabilitation and work with anxiety, and not with vascular drugs.
When your head is spinning not from your ear
If the feeling is closer to fainting - darkening in the eyes, weakness, perspiration - you need to look not in the inner ear. A therapist and a cardiologist work here, and the cause is often found in the medicine cabinet.
- Orthostatic hypotension—a drop in blood pressure when standing up; typically darkening of the eyes when getting out of bed or from the table, especially in the morning and in the heat
- Medicines are the most underestimated cause: blood pressure medications, diuretics, drugs for the treatment of prostate adenoma, antidepressants, sleeping pills, some antiallergic drugs
- Heart rhythm disturbances - episodes of lightheadedness without connection with body position, sometimes with interruptions and darkening of the eyes
- Anemia - general weakness, pallor, shortness of breath on exertion, lightheadedness
- Low glucose levels, especially in people with diabetes on therapy
- Dehydration, heat, prolonged standing, heat stress in the bathhouse
- Anxiety disorder and panic attacks - feeling of unreality, futility, fear of falling, rapid breathing
- Thyroid diseases, kidney dysfunction, side effects of alcohol
In older people, there is often more than one cause of dizziness: a combination of decreased vision, neuropathy of the legs, taking five to seven medications at once, decreased muscle strength and mild vestibular dysfunction. Each factor individually is insignificant, but together they lead to instability and declines. Therefore, in an elderly patient, the analysis usually begins with a review of the list of medications, checking the pressure in the lying and standing position, assessing vision and gait - and this often gives a better result than any vascular drugs.
When to suspect a stroke
The vast majority of cases of dizziness are not life-threatening. But there is a small proportion in which the rotation hides a circulatory disorder in the posterior parts of the brain and cerebellum, and it needs to be recognized in the first hours. The main rule: it is not dizziness itself that is dangerous, but its combination with other neurological symptoms.
- Double vision or loss of part of the visual field
- Speech impairment: slurring, difficulty finding words, lack of understanding of spoken speech
- Facial asymmetry, drooping corner of the mouth, inability to smile symmetrically
- Weakness or numbness in an arm, leg, or half of the body
- Swallowing problems, choking, voice changes
- Marked instability: a person cannot stand or walk even with support, falls to the side
- Severe headache that comes on suddenly, especially in the back of the head
- Dizziness new to a person with hypertension, diabetes, atrial fibrillation, or after a neck injury
There is one sign that is useful to know about: with benign vestibular causes, a person, albeit with difficulty and holding on to the wall, can stand and move. A complete inability to maintain balance, a fall to one side, and even more so a combination with any of the listed symptoms is reason to call an ambulance immediately, without waiting for the morning and without trying to “lie down.” Time here has a direct bearing on the outcome.
Examination and what really helps
A correct analysis of dizziness begins not with a tomography, but with a detailed conversation and examination. The doctor finds out the nature of the sensation, the duration of the attacks, provoking factors, the presence of auditory symptoms and concomitant diseases - and only after that decides what studies are really needed.
- Подробный расспрос: что именно ощущается, сколько длится, чем провоцируется, что было впервые и как менялось.
- Позиционные пробы для выявления ДППГ и определения вовлечённого канала.
- Оценка движений глаз, координации, походки и устойчивости, проверка черепных нервов.
- Измерение артериального давления и пульса лёжа и стоя, ЭКГ, при необходимости суточное мониторирование.
- Осмотр оториноларинголога и проверка слуха при подозрении на diseases внутреннего уха.
- Анализы: общий анализ крови, глюкоза, функция щитовидной железы, показатели обмена железа.
- МРТ головного мозга — при подозрении на центральную причину, при очаговых симптомах, при одностороннем снижении слуха или атипичном течении; в качестве первого шага при типичном ДППГ она не нужна.
- Ревизия всех принимаемых препаратов вместе с врачом.
What really works in treatment: addressing the specific cause and vestibular rehabilitation. The latter is a set of exercises for eye movements, head movements and balance training, which are performed regularly and gradually become more complex. Their point is to give the brain the opportunity to reconfigure and compensate for the violation. The effectiveness of vestibular gymnastics for most persistent forms is higher than that of any drugs, and it only costs time and discipline. Additionally, home safety is important if you are prone to falls - non-slip mats, lighting at night, grab bars in the bathroom - and vision correction.