It is a type of kinesthetic hallucination caused by dysfunction in the body's spatial orientation and balance. Clinically, it can be divided into vestibular system vertigo (true vertigo) and non-vestibular system vertigo (dizziness), with complex disease causes.

bubble_chart Diagnosis

1. Medical History Inquiry

1. Focus on understanding the nature of dizziness. True vertigo is characterized by a distinct sensation of self or external objects spinning, tilting, or visual instability. It is episodic and accompanied by nystagmus, balance disorders, unsteadiness, finger-pointing deviation, and autonomic symptoms such as nausea, vomiting, pallor, sweating, and changes in pulse and blood pressure. Lightheadedness often manifests as a heavy head and light feet, blurred vision, etc., without the hallucination of external or self-rotation. It can be caused by cardiovascular diseases, systemic poisoning, metabolic disorders, eye diseases, anemia, etc.

2. Differentiate whether vertigo is central or peripheral. Generally, peripheral vestibular vertigo presents with pronounced autonomic symptoms, predominantly horizontal nystagmus, and no neurological signs. In contrast, central vertigo has mild or absent autonomic symptoms and often involves symptoms of brainstem, cerebellar, or temporoparietal lobe damage.

3. Identify the triggers and accompanying symptoms of dizziness: - Otogenic vertigo is often accompanied by tinnitus and hearing loss, commonly seen in Ménière's disease, acute labyrinthitis, inner ear injury, tympanic membrane invasion or compression, and disorders of the otolith and vestibular end organs (e.g., traumatic brain injury, noise-induced injury, drug poisoning, and degenerative changes in the semicircular canal ampulla due to vertebrobasilar ischemia). - Cerebellopontine angle lesions are accompanied by symptoms of cranial nerves V, VII, IX, X, and pyramidal tract involvement. - Vestibular neuronitis is often triggered by upper respiratory or gastrointestinal infections without hearing changes. - Transient ischemic attacks of the vertebrobasilar artery are often induced by head position changes and accompanied by diplopia, visual distortion, numbness of the head, face, or limbs, syncope, and sudden falls. - Vertiginous epilepsy may involve loss of consciousness, grand mal seizures, or other epileptic symptoms. - Central vertigo caused by space-occupying lesions, inflammation, degeneration, or demyelination often involves signs of brainstem, cerebellar, or temporoparietal lobe damage.

1. Neurological examination: In addition to general neurological assessments, pay special attention to spontaneous nystagmus, ataxia, hearing impairment, fundus edema, and signs of increased intracranial pressure.

2. Internal medicine examination: Check for hypertension, hypotension, arrhythmia, heart failure, anemia, systemic infections, poisoning, metabolic disorders, etc.

3. Otological examination: Inspect the external auditory canal, tympanic membrane, middle ear, and nasopharynx for cerumen impaction, cholesteatomatous otitis media, or otosclerosis.

4. Tuning fork tests to assess hearing, the nature, and severity of hearing impairment.

3. Auxiliary Examinations

Imaging studies such as skull X-rays, EEG, cerebral blood flow tests, chest X-rays, TCD, cranial CT, and MRI are valuable for diagnosing the underlying causes of dizziness. For suspected cervical spondylosis, cervical spine X-rays (anteroposterior, lateral, and oblique views) are required. Vestibular function tests, including caloric testing, finger-pointing deviation, galvanic tests, positional tests, and electronystagmography, aid in the localization and qualitative diagnosis of vertigo.

bubble_chart Treatment Measures

1. General treatment

Patients with acute vertigo should rest in bed, avoid light stimulation, and relieve mental tension.

2. Disease cause treatment

For those with clear disease causes, active treatment targeting the cause should be implemented.

3. Symptomatic treatment:

The following medications can be selected

①Sedatives and tranquilizers: Luminal, Diazepam, etc.

②Antihistamines: Promethazine hydrochloride, Diphenhydramine hydrochloride, Chlorpheniramine, etc.

④Anticholinergic drugs: Scopolamine hydrobromide, Atropine.

⑤Vasodilators: Nicotinic acid, 654-2, Dibazole, etc.

4. Surgical treatment

For inner ear diseases with irreversible hearing loss that are refractory to long-term treatment, labyrinth destruction surgery or vestibular nerve section can be performed.