What's happening and why are you feeling dizzy?
The inner ear contains the vestibular apparatus, which constantly transmits information to the brain about the position and movement of the head. Signals from the right and left labyrinths are normally balanced. When a nerve is inflamed on one side, the flow of impulses decreases sharply, and the brain interprets the resulting asymmetry as rapid rotation. The illusion of movement of surrounding objects and involuntary rhythmic eye movements appear. Over time, the central nervous system is rebuilt and compensates for the lost function - rehabilitation is based on this.
- Damage to the vestibular nerve
- Sharp asymmetry of signals from labyrinths
- Illusion of rotation and nystagmus
- Preservation of hearing function
- Gradual central compensation
- Difference from labyrinthitis, in which hearing also suffers
Causes and risk factors
The most recognized cause is viral inflammation, most often associated with reactivation of the herpes simplex virus in the nerve ganglion. Often, one to two weeks before an attack, a person suffers from a respiratory infection. The role of impaired blood supply to the nerve is also discussed. Provoking factors are considered to be hypothermia, overwork, stress and decreased immunity. The disease occurs in people of any age, but more often on average, and usually does not recur: the previous episode, as a rule, remains the only one.
- Viral inflammation of the nerve
- Past respiratory infection
- Reactivation of herpes infection
- Hypothermia and fatigue
- Stress and decreased immunity
- Disruption of blood supply to a nerve
Symptoms
The attack begins suddenly, often in the morning: there is a feeling that the room is spinning, severe nausea and repeated vomiting, cold sweat, and a feeling of fear appear. Any movement of the head sharply increases dizziness, so the person lies motionless with his eyes closed. There is a noticeable deviation when trying to walk towards the affected ear. The hearing remains the same, there is no noise or congestion in the ear. The most severe manifestations last one to three days, then gradually subside, and instability when walking persists for weeks.
- Sudden severe rotational vertigo
- Nausea and repeated vomiting
- Increased with head movements
- Involuntary eye movements
- Unsteadiness and deviation when walking
- Safe hearing without tinnitus
- Gradual improvement over weeks
Diagnostics
The main task of the doctor is to distinguish neuronitis from a stroke in the cerebellum or brain stem, which can manifest itself in the same way. To do this, the nature of involuntary eye movements is assessed, special tests are performed with turning the head, coordination, sensitivity, speech and swallowing are checked. Vertical or changing direction nystagmus, double vision, weakness in the limbs, and speech impairment are alarming. If there is any doubt, or in people with risk factors for vascular events, an MRI of the brain is prescribed.
- Neurological examination and evaluation of nystagmus
- Quick head turn test
- Coordination and gait assessment
- Hearing test to rule out labyrinthitis
- MRI of the brain for suspected stroke
- Blood pressure measurement and ECG
- Rule out other causes of dizziness
Treatment and recovery
On the first day, medications are used to suppress nausea and dizziness, and fluids are replaced in case of repeated vomiting. It is fundamentally important not to take these drugs for a long time: they slow down the restructuring of the nervous system, so they are canceled after a few days. In some cases, the doctor prescribes a short course of hormonal therapy. The basis of recovery is vestibular gymnastics - special exercises for the eyes, head and balance, which begin as early as possible and are performed daily.
- Short-term use of antiemetics and vestibular drugs
- Replenishing fluids during vomiting
- Stopping suppressive drugs after a few days
- Glucocorticosteroids as prescribed by a doctor
- Early vestibular gymnastics
- Gradual expansion of activity
- Observation if instability persists
