dizziness

from Wikipedia, the free encyclopedia
Classification according to ICD-10
H81.0-9 Disorders of the vestibular function
H82 * Vertigo Syndromes in Diseases Classified Elsewhere
R42 Vertigo and
dizziness vertigo on A.
ICD-10 online (WHO version 2019)

Vertigo (from Middle High German swindel ) or Latin vertigo describes the sensation of turning or swaying, the feeling of not being able to move safely in space, or the feeling of impending unconsciousness . In the medical sense , vertigo is defined as a perceived apparent movement between oneself and the environment. A distinction is made between turning, swaying, lifting, movement and unsystematic vertigo.

In German, the word is therefore used for different phenomena, which makes communication between doctor and patient more difficult. In English, on the other hand, a distinction is made between vertigo (dizziness) and dizziness ( feeling light-headed ).

Etymologically, the word is probably derived from the Old High German "swintilon" ("to fall into a powerlessness" or "feel dizzy").

Epidemiology

Even though dizziness is very common, there are still few epidemiological studies . Colledge et al. a. report that 30% of people over 65 have experienced dizziness at least once a month in the previous year. Yardley et al. a. found dizziness at least once a month in 20% of 18 to 64 year olds. Sandholzer u. a. studied family doctor patients with an average age of 76 years, of whom 50% reported dizziness as a symptom.

Kroenke states that a somatic cause can be proven in about 20% of dizziness patients in general practice . Psychogenic causes must be assumed in around 15%. The remaining two-thirds cannot be diagnosed.

Dizzy types

Dizziness can have many different complex causes. During the examination, it is helpful to classify the vertigo into types of vertigo in order to narrow down the possible causes. The vertigo can be classified into two different categories, according to the type of vertigo (systematic or unsystematic) and according to the likely location of the trigger (etiology).

By type of vertigo: Systematic vertigo (directed vertigo):

  • Spinning vertigo: The patient feels like in a carousel, apparent movements ( oscillopsia ) occur. The causes here are mostly vestibular, i.e. H. they are located in the organ of equilibrium , but sometimes also in the central nervous system .
  • Elevator dizziness
  • Vertigo

Unsystematic vertigo (undirected vertigo):

According to etiology:

  • peripheral vestibular vertigo (labyrinth, vestibulocochlear nerve)
  • central vestibular vertigo
  • psychogenic dizziness
  • non-vestibular vertigo of organic origin

causes

Dizziness often arises from contradicting information from the sensory organs involved in the sense of balance , such as the eyes , balance organs of the inner ears, and muscle and joint receptors. Dizziness is one of the most common reasons for advice in a general practice.

The organ of equilibrium in the inner ear is a sensorium for rotational and linear acceleration and is closely related to reflexes .

A linear acceleration is registered in the macula sacculi and utriculi, which are in the horizontal and vertical planes. The sensory hairs of these receptors are embedded in a matrix weighted down by crystal grains, so-called otoliths. When accelerating in the plane of the macula, it remains behind due to its inertia and leads to a deflection of the sensory hair. By gravity , the position of the head can be determined in space with these receptors.

Rotational accelerations (rotational movements) are registered by sensory hairs in the semicircular canals - three mutually connected, perpendicular, ring-shaped vessels that are filled with lymph fluid . In the event of a rotary movement in the plane of the respective semicircular canal, the lymph fluid remains at rest due to its inertia in relation to the moving skull bone. In this way, the sensory hairs in the semicircular canals, which participate in the rotary movement, are deflected by the static fluid.

With prolonged rotating movements, friction causes the lymph to move along. When the semicircular canal and lymph move at the same speed, the sensory stimulus is reduced and ultimately tends to zero. It gets used to it. When the rotation stops, the liquid continues to rotate and creates the impression of an opposite rotation. The reflex reaction to this cannot be suppressed, even if the eye shows the true movement. The contradiction of the sense organs creates confusion or disorientation . During instrument flight , pilots must therefore learn to trust the display of navigation devices more than their sensory impressions.

Disorders of the equilibrium system (peripheral: inner ear + equilibrium nerve ; central: brain stem + cerebellum + cerebrum) can be the cause of dizziness: vestibular dizziness . Dizziness is often accompanied by vegetative reactions of the body such as nausea, vomiting, sweating, accelerated heart rate and collapse.

Examples:

A number of other causes have been described for non-vestibular dizziness , including precursors of fainting spells ( pre-syncope ) in arterial hypotension (low blood pressure), cardiac arrhythmias , probably blockages of the cervical vertebrae ( vertebral dizziness ), as well as epileptic discharges in the posterior parts of the Superior temporal gyrus at the vertigo epileptica .

Dizziness is also a common side effect of medication.

Scuba divers sometimes experience vertigo when cool water gets too deep into their ears. In this case, it helps to orientate yourself on the air bubbles, as these always rise upwards. The dive should be ended immediately - while observing the surfacing times.

Dizziness can also occur when looking from a great height. Holding on to stationary objects helps here.

Cervical injuries

Cervical injuries to the cervical spine and the head joint are exemplary and archetypal causes of dizziness, especially after whiplash injuries. As a result of the injury, physically referred to as the whiplash movement, which occurs primarily in the case of whiplash , head joint instability can exist. Head joint instability is caused by rupture or overstretching of ligamentous structures in the area of ​​the skull base (C0) to the second cervical vertebra (axis, C2). Injuries to the alarm ligaments , especially if the joint capsule ruptures at the same time, allow undesired incorrect movement, translational movement or, in the case of a unilateral injury, a so-called rotational subluxation between the first two cervical vertebrae ( atlas and axis ). This can lead to an intermittent basilar impression with typical brain stem symptoms. Characteristic for diffuse-hypoxic damage in the vertebral flow area (supply area of ​​the basilar artery) of the brain (occipital brain) are dizziness, vigilance disorders (from slight drowsiness to slight clouding of consciousness to pronounced somnolence ) and visual disturbances. Head joint instabilities are almost always accompanied by pronounced vertigo symptoms.

Extracranial Injuries

Dizziness is also a symptom of extracranial head injuries, i.e. injuries to the head caused by external violence, such as concussions and more severe traumatic brain injuries .

Mental illness

Symptoms of dizziness are often associated with mental illness . Dizziness can be both a consequence (so-called psychogenic dizziness) and a cause of a mental illness. Both diseases can also occur side by side ( comorbid ). Various studies have shown that mental illness had a significant influence on the course of the disease in 20–50% of vertigo patients.

Mental illnesses that often lead to dizziness are v. a. Depression , anxiety disorders and somatoform disorders . It may also be secondary somatoform dizziness , phobic postural vertigo (Engl. Phobic postural vertigo ), acute stress reactions and adjustment disorders come.

Examinations for dizziness

In order to clarify dizziness, patients often have to be examined by several specialists. If the general practitioner ( general medicine , internal medicine ) cannot adequately classify them, specialists in ENT , orthopedics and neurology should be consulted. Under certain circumstances, are cardiological and psychiatric examinations sense. Severe dizziness may require admission to hospital.

The following examination procedures are used:

  • always:
  • Depending on the findings of the examination, additional technical examinations:
    • Hearing test ( audiometry )
    • Brain stem audiometry
    • Balance test ( vestibular test ), for example through posturography ( balance analysis )
    • Electronystagmography (ENG) for the objective assessment of the oculomotor and vestibular system or the more modern video nystagmography (VNG)
    • occasionally imaging ( CT , MRI )
    • rarely also Doppler / duplex sonography , EEG or EPs
    • Otoacoustic emissions (TEOAE + DPOAE)
    • Head impulse test (KIT or HIT for English Head impulse test ) or video head impulse test (V-KIT). The video head impulse test is less dependent on the experience of the examiner and gives more accurate measurement results.
    • Vestibular evoked myogenic potentials (VEMP) are measured by electrodes placed on the skin. These recognize muscle tension that is directly caused by the perception of loud sounds.
    • Determination of the nerve conduction speed of the auditory nerve through early acoustic evoked potentials (FAEP or BERA for "Brainstem evoked response audiometry", for example: " Audiometric reaction evoked by the brain stem ")
    • Determination of the subjective visual vertical (SVV) or subjective haptic vertical (SHV) in the case of disorders of the utricle (see also pusher symptoms )

See also

literature

  • Thomas Lempert: Effective help with dizziness . Trias-Verlag, 2003, ISBN 3-8304-3105-8 .
  • Thomas Brandt, Michael Strupp, Marianne Dieterich: Vertigo. The main symptom is dizziness. Steinkopff, Darmstadt 2003, ISBN 3-7985-1416-X .
  • Michael Strupp, Thomas Brandt: Key symptom dizziness: diagnosis and therapy . In: Dtsch Arztebl . No. 105 (10) , 2008, pp. 173-180 ( Article ).

Web links

Wiktionary: Scam  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Drehwurm  - explanations of meanings, word origins , synonyms, translations

Individual evidence

  1. ↑ a b Michael M. Cooking: General medicine and family medicine. 2006.
  2. ↑ Current information on the therapy of dizziness and balance disorders , p. Stuckrad-Barre, S. Heitmann, WH Jost in the Hessisches Ärzteblatt from January 2007, p. 15ff, accessed in May 2016.
  3. ↑ According to W. Fink, G. Haidinger: The frequency of health disorders in 10 years of general practice. In: ZFA - Journal for General Medicine. 83, 2007, pp. 102-108, doi: 10.1055 / s-2007-968157 . Quoted from What family doctors mainly deal with , MMW-Fortschr. Med. No. 16/2007 (149th year).
  4. ↑ Undesired drug effects on the website of Stiftung Warentest from January 1, 2015, accessed on August 7, 2015.
  5. ↑ H. Schaaf: Psychogenic vertigo in ENT medicine . In: ENT. 49, 2001, pp. 307-315 (PDF; 222 kB) .
  6. ↑ a b J. Ronel, P. Henningsen: Psychological factors in vertigo diseases. In: E. Biesinger, H. Iro (ed.): ENT practice today. Volume 27: Vertigo . Springer, Heidelberg 2007, ISBN 978-3-540-47443-2 , pp. 99-108. doi: 10.1007 / 978-3-540-47448-7 .
  7. ↑ a b A. Eckhardt-Henn, P. Breuer, C. Thomalske, SO Hoffmann, HC Hopf: Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness . In: Anxiety Disorders. 17, 2003, pp. 369–388 (PDF; 184 kB) ( Memento of the original from January 31, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / faculty.ksu.edu.sa
  8. ↑ Christoph Best, Annegret Eckhardt-Henn, Regine Tschan, Marianne Dieterich: Why Do Subjective Vertigo and Dizziness Persist over One Year after a Vestibular Vertigo Syndrome? In: Ann. NY Acad. Sci. No. 1164, 2009, pp. 334-337.
  9. ^ H. Schaaf: Dizziness in the family doctor's practice . In: Z Allg Med. 84, 2008, pp. 252–257 (PDF; 131 kB) ( Memento of the original from January 31, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.online-zfa.de
  10. ↑ Michael Strupp, Thomas Brandt: Key symptom dizziness: diagnosis and therapy . In: Deutsches Ärzteblatt. 105 (10), 2008, pp. 173–80 (PDF; 327 kB)
  11. ↑ Annegret Eckhardt-Henn, SO Hoffmann, B. Tettenborn, C. Thomalske, HC Hopf: Phobic Schwankschwindel: A further differentiation of psychogenic states of vertigo seems necessary . In: The neurologist. 68 (10), 1997, pp. 806-812, doi: 10.1007 / s001150050198 .
  12. ↑ a b c d e Bodo Schiffmann, Mechthild Schiffmann: Dizziness is not fate. (PDF; 1.61 MB), In: Schwindelambulanz-Sinsheim.de; accessed in September 2019.