Vertigo is the most common clinical syndrome. With the aging of the population, the incidence of the disease is increasing day by day, which has been widely concerned by the medical community at home and abroad. Smith( 1993) reported that vertigo was the third common symptom in outpatient service. It involves many subjects, and most people have experienced it all their lives. According to statistics, vertigo accounts for 5% of the outpatient department of internal medicine and 15% of the outpatient department of otolaryngology. 50-60% of the elderly at home have dizziness, accounting for 81-91%of the elderly outpatient service; Among them, the incidence of vertigo in the elderly over 65 years old is 57% for women and 39% for men.
What is vertigo?
Dizziness is the general term for dizziness, with dizziness, blurred vision and darkness as dizziness; Seeing things spinning makes you dizzy, or you can't stand when everything is spinning, because you often see both at the same time, so it's called dizziness.
Classification of vertigo: true vertigo and false vertigo.
1, really dizzy
Refers to eye, proprioception or vestibular system diseases, with obvious foreign body sensation or self-rotation. According to the different damaged parts, it can be divided into ocular vertigo, proprioception vertigo and vestibular vertigo.
Vertigo symptoms caused by vestibular diseases are mostly serious, such as Meniere's syndrome, vertebrobasilar insufficiency, brain stem infarction and so on. , often relapse.
Ophthalmic vertigo can be a physiological phenomenon or a pathological phenomenon. If you stare at the scenery outside the window for a long time on the train, dizziness and railway nystagmus can appear; Looking down at the fleeting water under your feet on the Gao Qiao, you will feel dizzy and moving in the opposite direction. These are physiological vertigo induced by visual and optokinetic stimuli, and the symptoms will disappear after leaving the environment. Eye diseases such as acute ophthalmoplegia can lead to diplopia and dizziness.
Vertigo caused by proprioception disorder is called postural vertigo, which is found in syringomyelia and syphilis patients and is caused by deep sensory disorder and dyskinesia.
2. Non-vestibular chordal halo
It refers to dizziness caused by systemic diseases, such as cardiovascular and cerebrovascular diseases, anemia, uremia, drug poisoning, endocrine diseases, neurosis and so on. Almost all patients have different degrees of dizziness, and patients feel "floating" without a clear sense of rotation.
Medical history and clinical symptoms and signs
1, before the onset of vertigo
Whether there are excessive alcohol and tobacco, emotional instability, fatigue, insomnia and other factors before the onset.
2. Vertigo attack
(1) onset at night or in the morning, sudden onset or slow onset,
(2) First attack or recurrent attack;
(3) Under what circumstances, body position changes, neck torsion, or special body position;
(4) Whether the form of vertigo is rotating or non-rotating;
(5) whether the intensity can be sustained and whether the consciousness is awake;
(6) Whether dizziness is alleviated or aggravated when eyes are open and closed, and whether dizziness is aggravated when acousto-optic stimulation or changing body position.
3, dizziness with symptoms
(1) autonomic nervous symptoms: blood pressure changes, sweating, pallor, diarrhea;
(2) Ear symptoms: deafness, tinnitus and stuffy ears;
(3) Eye symptoms: black eyes, diplopia and blurred vision;
(4) Neck symptoms: neck or shoulder pain, numbness of upper limbs and limited movement;
(5) Central nervous system symptoms: headache, disturbance of consciousness, sensorimotor disorder, language or pronunciation disorder, etc.
What tests should dizziness do?
Vestibular function examination:
(1) Examination of vestibular function in clinic or bedside: including upright dumping test, standing still test, neck twisting test, etc.
(2) nystagmus
(3) electronystagmography
(4) Balance posture diagram
Auditory function examination:
Imaging examination: head CT, MRI and so on. Determine whether there is a head mass, ischemic or hemorrhagic disease.
Other medical examinations: including blood pressure, electrocardiogram and biochemical examination.
Various common systemic diseases with dizziness
1. Cerebrovascular vertigo: Sudden violent rotational vertigo accompanied by nausea and vomiting, gradually relieved after 10-20 days, mostly accompanied by tinnitus and deafness, but conscious.
2. Vertigo caused by brain tumor: Mild vertigo often occurs in the early stage, which can be a sense of swing and instability. Rotational vertigo is rare, and symptoms such as unilateral tinnitus and deafness often occur. With the development of the lesion, there may be signs of damage to the adjacent cranial nerves, such as numbness of the affected side, hypoesthesia and peripheral facial paralysis.
3, cervical vertigo: manifested as various forms of dizziness, accompanied by dizziness, trembling, unstable standing, ups and downs and other feelings. Vertigo recurs, and its occurrence is obviously related to the sudden rotation of the head, that is, it mostly occurs when the neck is active, and sometimes it presents postural vertigo when sitting up or lying down. Generally, the attack time is short, ranging from a few seconds to a few minutes, and some last longer. Neck or occipital pain may occur in the morning. Some patients may have symptoms of cervical nerve root compression, that is, arm numbness and weakness, and objects fall involuntarily. More than half of them can be accompanied by tinnitus, and 62-84% patients have headaches, which are mostly confined to the occipital region and often present paroxysmal jumping pain.
4, ocular vertigo: non-motor illusion vertigo, mainly manifested as instability, aggravated by excessive use of eyes, relieved after closing eyes. Vertigo lasts for a short time, which is aggravated when you open your eyes to see moving objects outside, and relieved or disappeared after you close your eyes. Often accompanied by blurred vision, decreased vision or diplopia. Vision, fundus and eye muscle function are often abnormal, and the nervous system has no abnormal performance.
5, cardiovascular vertigo: dizziness caused by hypertension can be clearly diagnosed by blood pressure measurement. Carotid sinus syndrome can cause paroxysmal dizziness or syncope. The inducing factors are mostly factors that suddenly cause carotid artery compression, such as sharp neck turn, bow, tight collar and so on.
6. Endocrine vertigo: Hypoglycemic vertigo often occurs before starvation or eating, and lasts for tens of minutes to 1 hour. Symptoms are relieved or disappeared after eating, often accompanied by fatigue. Check the blood sugar during the attack and you can find hypoglycemia. Thyroid dysfunction can also lead to dizziness, and the main obstacle in clinic is balance disorder. The related examination of thyroid function can confirm the diagnosis.
7. Dizziness caused by blood diseases: leukemia, pernicious anemia, hypercoagulable diseases, etc. It can cause dizziness and can be diagnosed by blood system examination.
8. Neurofunctional vertigo: Patients have various symptoms, and dizziness is mostly pseudovertigo, often accompanied by headache, head swelling, heaviness, or neurosis such as insomnia, palpitation, tinnitus, anxiety, dreaminess, inattention, memory loss, and no sense of rotation or shaking of foreign objects. For women over 45 years old, we should also pay attention to the differentiation from menopausal syndrome.
Prevention and treatment of vertigo
Vertigo patients should be accompanied by their families when they go out to prevent accidents.
1. Cerebrovascular vertigo: Due to the increase of blood viscosity in Xia Dong season, various cerebrovascular accidents are prone to occur, leading to the occurrence of cerebrovascular vertigo. You should pay attention to drink more water and don't change your posture suddenly. If you go to the toilet suddenly at night, it is easy to cause cerebrovascular vertigo. Once it happens, you should go to the hospital as soon as possible. After the diagnosis, you can give vasodilators, antiplatelet drugs (such as aspirin) and anticoagulants.
2. Vertigo caused by brain tumor: This kind of vertigo has a slow onset and mild initial symptoms, which is not easy to find. For progressive mild vertigo, if accompanied by unilateral tinnitus, deafness and other symptoms, or other signs of adjacent brain nerve damage, such as numbness, hypoesthesia, peripheral facial paralysis and so on. You should go to the hospital as soon as possible for diagnosis and early surgical treatment.
3, cervical vertigo: usually work and study should pay attention to posture, after a long time at the desk to properly move the neck. The height of the pillow should be appropriate, and the pillow should not be too high, which will lead to cervical vertigo. Rehabilitation methods are often used in treatment, such as cervical pillow sling traction, massage therapy, acupuncture and so on. Need major surgery.
4. For vertigo caused by other diseases, such as endocrine vertigo, hypertensive vertigo and ocular vertigo, we should actively treat the primary disease, such as controlling blood pressure and treating ophthalmic diseases. On the basis of the recovery of the primary disease, dizziness can be relieved naturally.
5. Neurofunctional vertigo: For vertigo caused by mental factors, patients' anxiety should be relieved first, and anti-anxiety or antidepressant drugs can be given appropriately, but long-term use of sedatives should be avoided to avoid increasing drug tolerance and dependence.
label
The clinical manifestations of vertigo are complex and diverse, involving many disciplines and dozens of diseases. Patients should actively prevent and control the primary disease; Once symptoms appear, you should go to the hospital as soon as possible to avoid delaying your illness.
Vertigo, usually called dizziness, is a common symptom. The mild attack is short-lived, and it can return to normal after lying on your back and closing your eyes for a while; Seriously ill patients are like sitting in a car or a boat, feeling very dizzy and even unstable. Most patients have mild or severe illness, and other symptoms last for a long time. It is more common in diseases such as hypertension, arteriosclerosis, anemia, neurosis and otogenic vertigo.
Hand massage is effective in treating vertigo. However, patients must cooperate with doctors to find the cause and actively treat the primary disease. Hand massage can be used as an auxiliary method in comprehensive treatment. Clinical treatment shows that for vertigo caused by inner ear vertigo, labyrinthitis, motion sickness, basilar artery insufficiency and systemic diseases, manual massage combined with traditional Chinese medicine has a good effect.
【 Massage and acupoint selection 】
Meridian points: Neiguan, Yanggu and Zheng Zhi.
Reflex areas: pituitary, cerebellum and brain stem, brain, neck, inner ear labyrinth, ears, eyes, liver, kidney, adrenal gland, thyroid gland, spleen, etc.
Reaction point: heart point, etc.
Holographic points: scalp points, etc.
[Massage Method]
Press Neiguan 200 times, Yanggu and Zheng Zhi 50 times each; Click on pituitary, cerebellum and brain. Brain, inner ear lost, ear, eye, liver and kidney 200 times each, adrenal gland, thyroid gland and spleen. One for each time 1OO; Massage the center point 300 times and pinch the joint point 500 times. Massage every day 1 time, one course of treatment for l months 1, which can last for 3-4 courses according to the treatment situation.
Patients with vertigo should pay attention to diet and daily life, adjust coldness and temperature to avoid excessive fatigue; Measure blood pressure regularly, quit smoking and drinking, be careful about sexual intercourse, maintain emotional stability and avoid mental stimulation. When vertigo attacks, you should lie on your back and close your eyes, keep the environment quiet, eat lightly, and eat less and more meals. If dizziness occurs repeatedly, it is not advisable to work at high altitude or on water. Patients with hypertension should consider the omen of stroke if they suddenly feel dizzy.
Finidoic acid
Pharmacology:
pharmacodynamics
This product can improve vertebrobasilar insufficiency, regulate vestibular nervous system, treat various central and peripheral vertigo, inhibit vomiting and nystagmus, and resist motion sickness. This product also has a weak peripheral anti-M- choline effect.
pharmacokinetics
This product is absorbed by gastrointestinal tract, and the blood concentration reaches the peak at 1.5 ~ 3 hours after taking the drug. The half-life is 4 hours. Excretion from urine in its original form.
[Pharmacology] This product can dilate spasmodic blood vessels and increase cerebral artery blood flow, especially basilar artery blood flow. In addition, this product can regulate the abnormal impulse of vestibular nerve, inhibit vomiting center and improve nystagmus, so it can be used for patients with dizziness and vomiting. This product has no antihistamine effect, no sedative effect and no anesthetic enhancement effect.
pharmacokinetics
This product is absorbed by gastrointestinal tract after oral administration, and the peak time of plasma concentration is 1.5 ~ 3h, and the metabolites are excreted in urine.
Indications:
Used for dizziness and vomiting caused by various diseases (such as vertebrobasilar insufficiency, Meniere's disease, autonomic nervous dysfunction, hypertension, hypotension, cervical vertigo, trauma or drug poisoning) and vomiting after surgical anesthesia; It can prevent and treat motion sickness.
This product can be used to treat vertigo caused by various reasons, such as vertebrobasilar insufficiency, Meniere's disease, autonomic nerve dysfunction, cervical vertigo, motion sickness, etc. Clinical observation shows that its effective rate is above 80%. This product has high curative effect, no adverse reactions such as drowsiness or excessive excitement, and does not affect the normal work of personnel. It can be used as the main drug for treating vertigo.
Usage and dosage:
Adults generally take it orally, 25-50mg once, three times a day.
[Preparation and Specification] Difenidot Hydrochloride Tablets 25mg
Oral administration, 25-50mg once, three times a day.
【 Usage and Dosage 】 Take orally, 25 ~ 50mg each time, three times a day. Intramuscular injection, 10 ~ 20 mg each time, 1 ~ 2 times a day.
[Formula and Specification] Tablets: 25mg// tablet. Injection: 10 mg/ml.
Disable warning:
Because this product has mild anti-M- choline effect, it should be used with caution for glaucoma, gastrointestinal or urinary tract obstructive diseases, tachycardia, and renal insufficiency.
Use it with caution in patients with glaucoma, and avoid it in patients with severe renal function damage and allergies.
Adverse reactions:
Mainly dry mouth and mild gastrointestinal discomfort, which can disappear after stopping the drug. In addition, it is reported that auditory hallucinations, hallucinations, disorientation, insanity, lethargy, anxiety, depression and anti-M- choline effects may occur, as well as occasional transient hypotension, headache and rash.
The main manifestations are dry mouth and stomach discomfort. A few patients have tinnitus, drug eruption, chills in hands and feet, loss of appetite, drowsiness and palpitations. The total incidence of various side effects is about 10%. The occurrence of the above side effects does not affect the continued treatment. —It usually disappears after stopping taking medicine.
Interaction:
Taking difenidol first can reduce the emetic effect of apomorphine in the treatment of poisoning.
This product can be combined with other drugs to increase blood supply to the brain and enhance its anti-vertigo effect.
Vertigo patients should pay attention to the combination of work and rest, avoid fatigue, keep enough sleep and avoid mood swings. Anxiety, anger, nervousness, fear, anxiety, etc. May cause dizziness. Pay attention to a light diet, don't drink alcohol, stay in bed absolutely, and don't shake your head from side to side during dizziness.