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").
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.
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
Unsystematic vertigo (undirected vertigo):
- Second dizziness: the patient feels as if they are passing out. If this happens suddenly, bradycardiac arrhythmias and a sensitive carotid sinus must be taken into account. With Prodromi one should think of orthostasis and tachycardiac arrhythmias .
- Uncertainty of space: Patients report a strange feeling in their head. This is either fluctuating and can only be triggered by head movements ( CNS , eyes , vestibular , benign positional vertigo ) or permanently present ( psyche , CNS , medication , hyperventilation ).
- Unsteady gait: This does not depend on the position of the head or head movements, the head is free. This type of dizziness can only be triggered, if at all, by movements of the body. The cause can lie in the peripheral nervous system , CNS , the eyes or the psyche .
According to etiology:
- peripheral vestibular vertigo (labyrinth, vestibulocochlear nerve)
- central vestibular vertigo
- psychogenic dizziness
- non-vestibular vertigo of organic origin
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.
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.
- Benign paroxysmal positional vertigo , a benign positional vertigo
- Diseases of the inner ear (vestibulopathy)
- Meniere's disease
- Inflammation of the organs of equilibrium ( vestibular neuritis )
- Circulatory disorders ( ischemic stroke of the brainstem ), tumors ( acoustic neuroma ), mechanical damage (traumatic labyrinth failure with temporal bone fracture ), etc. with involvement of the equilibrium system
- Migraine with brainstem aura (also known as Bickerstaff syndrome or basilar migraine), vestibular migraine
- Basilar compression due to rotational or translative subluxations in the head joint in the case of head joint instabilities, for example as a result of whiplash with soft tissue injury
- Superior canal dehiscence , a bone defect in the inner ear, which to autophony , dizziness, Tullio phenomenon and hearing loss may lead
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 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.
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:
- 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 )
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