Severe dizziness can be constant or paroxysmal, occurs with vestibular neuronitis, pathologies of the inner ear, cerebrovascular accidents, idiopathic vestibular insufficiency, some cardiac pathologies, intoxication, severe anemia, panic attacks. It is diagnosed on the basis of survey data, neurological examination, studies of the vestibular apparatus, imaging, laboratory techniques. Treatment includes neuroprotective agents, vascular agents, analgesics, anticonvulsants, and other drugs. Some patients require surgery.
Severe dizziness is an intense sensation of movement (rotation or displacement) of the patient himself or the space surrounding him in the absence of such changes objectively. It can be short-term, long-term, permanent. It is divided into systemic and non-systemic. Systemic vertigo, in turn, is divided into central (with involvement of the inner ear, vestibular nerves and ganglia) and peripheral (due to damage to the cerebellum, brain stem).
Severe systemic vertigo is characterized by a sensation of movement in space, falling through, swaying on the waves, instability or shifting of the support under the feet. Non-systemic dizziness occurs due to the inconsistency of vestibular, visual and proprioceptive perception. Accompanied by a feeling of instability, difficulty in maintaining posture.
Motion sickness (kinetosis) is a condition that develops as a result of excessive irritation of the vestibular apparatus. Includes airsickness, seasickness, dizziness when riding a horse, traveling in a car, driving on attractions. It is also observed with monotonous movements of the head and body, especially rotational ones. In severe cases, it is accompanied by severe dizziness, severe nausea, and sometimes repeated vomiting.
It worsens during pregnancy, after overeating, drinking alcohol, when exposed to additional adverse factors (noise, smells), the presence of some somatic and neurological diseases, increased anxiety. Symptoms usually disappear quickly after the cessation of vestibular hyperstimulation. In some patients, gradually weakening dizziness persists for several days.
The cause of dizziness is the following lesions of the vestibular analyzer:
severe dizziness
The clinical picture, including severe dizziness and vegetative symptoms, is formed acutely, lasting from several hours to several days. The cause of vestibular neuronitis is inflammation of the nerve after a viral or bacterial infection, less often - the use of aminoglycosides. Hearing impairment, focal and meningeal neurological symptoms are absent. A distinctive feature is the solitary nature of the attack. The second episode of dizziness is observed in only 2% of patients, the previously intact nerve is always affected.
The reasons for the development have not been established. It is manifested by repeated episodes of severe dizziness, oscillopsia (sensation of vibration of immovable objects). There are no hearing impairments. Disorders of balance and oscillopsia gradually increase. Over time, the same picture is formed as with symptomatic bilateral vestibular insufficiency against the background of other diseases (for example, Meniere's disease). Oscillopsia is provoked by changes in the position of the body or head, walking in the dark, on uneven surfaces becomes impossible.
Severe dizziness lasting more than a day may indicate the development of a stem or cerebellar stroke. With a sharp decrease in hearing, it is worth suspecting a concomitant labyrinth infarction. Vertical strabismus, certain types of nystagmus indicate damage to the central vestibular structures. When the trunk is involved, tetra- or hemiparesis, Horner's syndrome and Babinsky's symptom are observed, with strokes in the cerebellum region - dysarthria, ataxia.
Unlike strokes, with TIA, dizziness and other symptoms completely disappear within a day. Possible violations of sensitivity, transient paresis, diplopia, dysarthria, unsteadiness of walking. In patients with cerebral atherosclerosis, severe dizziness is permanent. Occurs in old age. Complemented by a decrease in working capacity, insomnia, headaches, memory impairment. Symptoms progress over time.
The cause of severe dizziness is a sudden decrease in cardiac output. Myocardial infarction is manifested by intense pain in the chest, fear of death. With bradycardia, sick sinus syndrome and Frederick's syndrome, attacks develop against the background of pain and discomfort in the heart, weakness, shortness of breath, and exercise intolerance.
In addition, a symptom occurs with orthostatic collapse - a lack of blood supply to the brain due to a decrease in blood pressure when changing body position (suddenly standing up). The condition is formed against the background of weakened vascular tone. It can be an individual feature, found in hypovolemia of various origins, some vascular and neurological diseases, including vegetative-vascular dystonia.
Severe non-systemic dizziness in combination with balance disorders is a sign of toxic damage to the cerebellum due to the use of benzodiazepines, lithium, antiepileptic drugs. Dysarthria, gaze-induced nystagmus, ataxia, more pronounced in the trunk area, are determined. In the anamnesis, treatment with the listed means is revealed.
With alcohol intoxication, the symptoms are supplemented by positional nystagmus (occurring when the head is tilted). In the first 3 hours after taking alcohol, nystagmus is directed to the lower ear, then to the upper one. Carbon monoxide poisoning is characterized by dizziness, pressing headache, nausea, vomiting, visual disturbances, unsteady gait, arrhythmia, tachycardia. Possible psychomotor agitation, reduced criticism.
The severity of the symptom in anemia correlates with the severity of the disease. In patients with iron deficiency anemia, the manifestations progress slowly, gradually, reaching significant severity in the absence of treatment. Complemented by shortness of breath, palpitations, weakness, pallor, dry skin. In patients with sickle cell anemia, severe dizziness accompanies sequestration crises, during which blood pressure drops sharply due to the deposition of blood in the liver and spleen.
Paroxysmal non-systemic dizziness is one of the main complaints of people suffering from panic attacks. It is combined with lightheadedness, darkening of the eyes, ringing in the ears, tachycardia, various vegetative symptoms, peak emotional experiences. It can be observed with depression, neurasthenia, hypochondria. Often found in patients with hysteria. It lasts 15-2 minutes, sometimes up to 1 hour.
The symptom is part of the clinical picture of a number of acute conditions:
The cause of severe dizziness is determined by a neurologist. Taking into account the existing symptoms, the patient may be referred for a consultation with a vestibulologist, otolaryngologist, cardiologist, and other specialists. Dizziness is subjective, often difficult to describe. Therefore, the most important task at the initial stage of the examination is to reliably establish the fact of the presence of a symptom by differentiation with other manifestations (visual impairment, headache).
The specialist refrains from offering his own formulations, collects complaints in detail, asks about feelings. To determine the level of damage, a detailed neurological examination is performed to confirm neurological disorders, coordination disorders, the presence and type of nystagmus, and the preservation of the vestibulo-ocular reflex. The final diagnosis is made according to the results of the following procedures:
Vestibulologist's consultation
Therapeutic tactics is determined by the type of pathology that provoked severe dizziness:
Depending on the etiology of severe dizziness, patients may be shown the following operations: