STUDY - Technical - New Dacian's Medicine
Dizziness
and Vertigo
(2)
Translation Draft
Today I'm going to post less than usual for health reasons... So I'm going to complete the vertigo without moving on, as I should have...
Treatment in acute vertigo consists of bed rest and administration of vestibular suppressor drugs, such as antihistamines, centrally acting anticholinergics or tranquilizers with GABA-ergic effects (diazepam). If vertigo persists for several days, most specialists suggest mobilization, in an attempt to induce central compensatory mechanisms, despite the short-term discomfort of the patient. Chronic vertigo of labyrinthine origin can be treated by a systematized program of exercises to facilitate compensation.
Prophylactic measures to prevent recurrent vertigo have a variable effectiveness, Meniere's disease can respond to an undated diet, etc.. Antihistamines are commonly used. In addition there are a variety of surgical procedures of the inner ear for all forms of chronically refractory or recurrent vertigo, but they are rarely necessary.
Easily categorisable as vertigo there are also "other types of head sensations". This expression is mainly used for the purpose of an initial classification, to describe dizziness that is neither passing out nor vertigo. Cephalic ischemia or vestibular dysfunction may have a sufficiently low intensity that the usual symptomatology is not accurately identified.
For example, a slight drop in blood pressure or a slight vestibular imbalance can cause different sensations from distinct to vertigo, but can be identified exactly during the test challenge techniques. Other causes of dizziness in this category are hyperventilation syndrome, hypoglycaemia and somatic symptoms of clinical depression (these patients need to have neurological examinations and vestibular functional tests within normal limits).
There are also correlations with gait disorders. Some people with gait disorders complain of dizziness, despite the absence of vertigo or other abnormal cephalic sensations. Causes include peripheral neuropathy, myelopathy, spasticity, parkinsonian stiffness and cerebellar ataxia. In this context, the term dizziness is used to describe impaired mobility.
There may be mild associated instability, especially in the case of impaired lower limb sensations or visual disturbances, which is known as dizziness through multiple sensory defects and occurs in older people who complain of dizziness only during walking. A diminished sense of position (secondary to neuropathy or myelopathy) and decreased vision (cataract or retinal degeneration) lead to overuse of the vestibular apparatus in wear and tear. A less precise but sometimes reassuring term is that of "benign imbalance of the elderly".
And, to complete, the most important means of diagnosis is a careful anamnesis, focused on the meaning that the patient assigns to the term "dizziness" (additional in the effort to determine whether it is a weakness, whether it is a spinning sensation, etc.). if one of these is confirmed and the neurological examination is normal, appropriate investigations for the multiple etiologies of cephalic ischemia or vestibular dysfunction shall be carried out.
When the term dizziness is unclear, challenge tests can be useful, cabinet tests that simulate either cephalic ischemia or vestibular dysfunction. Cephalic ischemia is evident if dizziness is doubled during orthostatic hypotension. Further challenge tests include the Valsalva maneuver, which decreases cerebral blood luxury and should replicate ischemic symptoms.
The simplest challenge test for vestibular dysfunction is rapid rotation and sudden interruption of movement in a rotating chair. It always produces vertigo, which patients can compare to their symptomatic dizziness. Intensely induced vertigo may be different from spontaneous symptoms, but shortly after remission of vertigo a feeling of instability may occur that can be identified as "own dizziness".
When this happens, the dizziness patient initially diagnosed as suffering from "various cephalic sensations", is now correctly diagnosed as exhibiting vertigo slightly secondary to vestibulopathy. Patients with symptoms of positional vertigo should be properly tested, positional testing being more sensitive, with special glasses that prevent visual fixation (Frenzel lenses).
A final challenge test, which requires the use of Frenzel lenses, consists of vigorous shaking of the head horizontally for about 10 seconds. If nystagmus occurs when stopping movement, even in the absence of vertigo, vestibular dysfunction is demonstrated. the manoeuvre can then be repeated in the vertical plane. if the challenge tests establish dizziness as a vestibular symptom, proceed to the previously described assessment of vestibular vertigo.
Hyperventilation is the cause of dizziness in many anxious individuals, with paresthesia in the hand and face may be absent. Forced hyperventilation for 1 minute is indicated in patients with unexplained dizziness and normal neurological examinations. Similarly, depressive symptoms (which patients insist on as "secondary" to dizziness) should alert the examiner to clinical depression as a cause, rather than as an effect, of dizziness.
CNS diseases can cause dizziness of all kinds. Consequently, a neurological examination is always necessary, even if anamnesis or challenge tests suggest cardiac, peripheral vestibular or psychogenic etiology. Any abnormality of the neurological examination must hasten appropriate neurodiagnostic investigations.
The next step of my posts will be muscle weakness, abnormal movements and imbalance (which is not similar to dizziness or vertigo), along with spasms, cramps and episodic muscle weakness, which I will group under the name of somatic dysfunctions (all under the "wolf" of nervous system disorders).
Today I'm going to post less than usual for health reasons... So I'm going to complete the vertigo without moving on, as I should have...
Treatment in acute vertigo consists of bed rest and administration of vestibular suppressor drugs, such as antihistamines, centrally acting anticholinergics or tranquilizers with GABA-ergic effects (diazepam). If vertigo persists for several days, most specialists suggest mobilization, in an attempt to induce central compensatory mechanisms, despite the short-term discomfort of the patient. Chronic vertigo of labyrinthine origin can be treated by a systematized program of exercises to facilitate compensation.
Prophylactic measures to prevent recurrent vertigo have a variable effectiveness, Meniere's disease can respond to an undated diet, etc.. Antihistamines are commonly used. In addition there are a variety of surgical procedures of the inner ear for all forms of chronically refractory or recurrent vertigo, but they are rarely necessary.
Easily categorisable as vertigo there are also "other types of head sensations". This expression is mainly used for the purpose of an initial classification, to describe dizziness that is neither passing out nor vertigo. Cephalic ischemia or vestibular dysfunction may have a sufficiently low intensity that the usual symptomatology is not accurately identified.
For example, a slight drop in blood pressure or a slight vestibular imbalance can cause different sensations from distinct to vertigo, but can be identified exactly during the test challenge techniques. Other causes of dizziness in this category are hyperventilation syndrome, hypoglycaemia and somatic symptoms of clinical depression (these patients need to have neurological examinations and vestibular functional tests within normal limits).
There are also correlations with gait disorders. Some people with gait disorders complain of dizziness, despite the absence of vertigo or other abnormal cephalic sensations. Causes include peripheral neuropathy, myelopathy, spasticity, parkinsonian stiffness and cerebellar ataxia. In this context, the term dizziness is used to describe impaired mobility.
There may be mild associated instability, especially in the case of impaired lower limb sensations or visual disturbances, which is known as dizziness through multiple sensory defects and occurs in older people who complain of dizziness only during walking. A diminished sense of position (secondary to neuropathy or myelopathy) and decreased vision (cataract or retinal degeneration) lead to overuse of the vestibular apparatus in wear and tear. A less precise but sometimes reassuring term is that of "benign imbalance of the elderly".
And, to complete, the most important means of diagnosis is a careful anamnesis, focused on the meaning that the patient assigns to the term "dizziness" (additional in the effort to determine whether it is a weakness, whether it is a spinning sensation, etc.). if one of these is confirmed and the neurological examination is normal, appropriate investigations for the multiple etiologies of cephalic ischemia or vestibular dysfunction shall be carried out.
When the term dizziness is unclear, challenge tests can be useful, cabinet tests that simulate either cephalic ischemia or vestibular dysfunction. Cephalic ischemia is evident if dizziness is doubled during orthostatic hypotension. Further challenge tests include the Valsalva maneuver, which decreases cerebral blood luxury and should replicate ischemic symptoms.
The simplest challenge test for vestibular dysfunction is rapid rotation and sudden interruption of movement in a rotating chair. It always produces vertigo, which patients can compare to their symptomatic dizziness. Intensely induced vertigo may be different from spontaneous symptoms, but shortly after remission of vertigo a feeling of instability may occur that can be identified as "own dizziness".
When this happens, the dizziness patient initially diagnosed as suffering from "various cephalic sensations", is now correctly diagnosed as exhibiting vertigo slightly secondary to vestibulopathy. Patients with symptoms of positional vertigo should be properly tested, positional testing being more sensitive, with special glasses that prevent visual fixation (Frenzel lenses).
A final challenge test, which requires the use of Frenzel lenses, consists of vigorous shaking of the head horizontally for about 10 seconds. If nystagmus occurs when stopping movement, even in the absence of vertigo, vestibular dysfunction is demonstrated. the manoeuvre can then be repeated in the vertical plane. if the challenge tests establish dizziness as a vestibular symptom, proceed to the previously described assessment of vestibular vertigo.
Hyperventilation is the cause of dizziness in many anxious individuals, with paresthesia in the hand and face may be absent. Forced hyperventilation for 1 minute is indicated in patients with unexplained dizziness and normal neurological examinations. Similarly, depressive symptoms (which patients insist on as "secondary" to dizziness) should alert the examiner to clinical depression as a cause, rather than as an effect, of dizziness.
CNS diseases can cause dizziness of all kinds. Consequently, a neurological examination is always necessary, even if anamnesis or challenge tests suggest cardiac, peripheral vestibular or psychogenic etiology. Any abnormality of the neurological examination must hasten appropriate neurodiagnostic investigations.
The next step of my posts will be muscle weakness, abnormal movements and imbalance (which is not similar to dizziness or vertigo), along with spasms, cramps and episodic muscle weakness, which I will group under the name of somatic dysfunctions (all under the "wolf" of nervous system disorders).
Health,
that's better than all... If the Good Lord wants me to post
everything I have set out to do with New Medicine, you will
all see that health is the same as peace of mind, inner
happiness, our capacity for understanding towards ourselves
and those around us, about everything that surrounds us,
implicitly the ability to give and receive love and gratitude.
Dorin, Merticaru