Sharp Dizziness : Causes, Symptoms, Diagnosis & Treatment

• General Characteristics
• Why Does Severe Dizziness Occur?
• Inner Ear Lesions
• Arrhythmia
• Transient Ischemic Attack
• Temporal Lobe Epilepsy
• Panic Attacks
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Severe dizziness is possible with vestibular paroxysms, BPPV, cardiac arrhythmias, transient ischemic attacks, Meniere's disease, Lermoyer's syndrome, labyrinthitis, temporal lobe epilepsy, perilymphatic fistula, panic attacks. It is manifested by an attack of a pronounced sensation of rotation or displacement of the patient, less often - of the surrounding space. To clarify the diagnosis, a neurological examination is performed, studies to assess the vestibular analyzer, EEG, CT, MRI. Treatment includes antipsychotics, antihistamines, antiplatelet agents, anticoagulants, and other agents. Surgical interventions are carried out according to indications.

general characteristics

Acute dizziness is a paroxysm lasting from a few seconds to several hours, accompanied by the illusion of movement. During an attack, the patient may feel how he himself rotates or shifts in different planes, although, in fact, there are no changes. Sometimes it seems to patients as if the immovable environment is shifting.

In most cases, severe dizziness is systemic. A symptom can occur for no apparent reason, provoked by a change in the position of the head, lack of sleep, loud sounds, strong emotional experiences. The most common associated manifestations are headache, hearing loss, and palpitations.

Why does severe dizziness occur?

Inner ear lesions

Severe dizziness is caused by damage to the vestibular analyzer located in the inner ear. The symptom is detected in the following pathologies:

• Labyrinthitis. In the acute form of the disease or exacerbation of a chronic process, an attack of intense dizziness lasts from 2-3 minutes to 1-2 or more hours. In the remission phase, the duration of the episode is several minutes. The symptom is associated with nausea, vomiting, increased sweating, redness or pallor of the face, tinnitus, or hearing loss.
• Meniere's disease. Pathology is non-inflammatory in nature, the manifestation is due to an increase in pressure in the labyrinth, provoked by alcohol intake, overwork, physical activity and other factors. Severe dizziness persists for 2-8 hours, less often for several seconds or several days. The patient cannot sit or stand, suffers from nausea and repeated vomiting.
• Lermoyer syndrome. It is considered as a separate nosology or an atypical form of Meniere's disease. Paroxysms are biphasic in nature, develop as a result of spasm of the arteries of the labyrinth. In the first phase (from 1-2 days to 2 or more weeks) there is an increasing high-pitched noise in the ear, in the second (from 2 minutes to 3-4 hours) there is a sharp systemic dizziness.
• Perilymphatic fistula. It is observed during the formation of an anastomosis between the labyrinth and the middle ear. Episodes of vertigo are preceded by rapid hearing loss or sudden deafness. The symptom is aggravated by pressing the tragus, loud sounds, changes in atmospheric pressure, coughing, sneezing.

BPPV and vestibular paroxysms are not accompanied by organic changes in the structures of the inner ear. The basis of vestibular paroxysms is irritation of the cochlear nerve by a nearby vessel in atherosclerosis, malformations. Sometimes the condition is observed with neoplasms of the brain, after operations. The episode lasts 1-2 minutes, is complemented by hearing disorders and tinnitus. In some cases, a connection between the attack and changes in the position of the head is revealed.

The cause of benign paroxysmal positional vertigo is otoliths formed as a result of head injury, surgical procedures, taking ototoxic drugs, and other causes. The attack is potentiated by turning or throwing back the head, lasts no more than 3 seconds. There are no hearing impairments. After the cessation of severe dizziness, a feeling of "lightheadedness" is possible.

Dizziness

Arrhythmia

The symptom is noted with some rhythm disturbances. Frederick's syndrome is a combination of atrial fibrillation and complete atrioventricular block. It is observed in ischemic heart disease, myocardial infarction, cardiomyopathies, myocarditis, overdose of certain drugs. The manifestation occurs against the background of shortness of breath, weakness, intolerance to physical exertion, pain in the heart. Episodes of severe dizziness and fainting may also be due to sick sinus syndrome or sinus bradycardia.

Transient ischemic attack

Short-term circulatory disorders in the brain occur in patients with atherosclerosis, hypertension, and some cardiac pathologies. Severe dizziness against the background of a transient ischemic attack (TIA) is possible with damage to the arteries of the vertebrobasilar basin. Unsteadiness, unsteadiness of walking, dysarthria, diplopia, disorders of sensitivity and movements are observed. All manifestations disappear within a day.

temporal lobe epilepsy

Simple sensory seizures in temporal lobe epilepsy can be episodes of systemic dizziness, sometimes with signs of vestibular ataxia, a sense of changes in the surrounding space. They arise independently or are an aura that precedes complex partial or secondary generalized seizures.

Panic attacks

Dizziness and other manifestations of a panic attack are caused by disturbances in the activity of the autonomic nervous system under the influence of psychogenic, biological and physiogenic factors. The symptom is provoked by conflicts, stress, traumatic events, hormonal changes, physical exertion, weather changes, alcohol or drugs.

A panic attack is formed on the background of anxiety. The increased production of adrenaline causes an increase in blood pressure, tachycardia, and increased respiration. Due to hyperventilation, severe dizziness, lightheadedness, and derealization occur. Cold extremities, discomfort in the abdomen, difficulty swallowing, nausea are possible. Usually the paroxysm lasts no more than 15 minutes, in rare cases its duration increases to 1 hour.

Diagnostics

Neurologists are engaged in establishing the causes of severe dizziness. The most important part of the examination is the compilation of a detailed description of the symptom. Patients often confuse dizziness with other manifestations (for example, a sudden decrease in visual clarity), so during the conversation, the specialist should restore a detailed picture of the patient's feelings during the attack.

Determination of the nature of dizziness (systemic, non-systemic), provoking factors, frequency and duration of episodes may indicate the localization of the pathological focus and the possible cause of the symptom. Clinical examination involves the assessment of the following indicators:

• Spontaneous nystagmus . It is noted with central and peripheral vestibular disorders. The study is supplemented by a head turn test to detect the vestibulo-ocular reflex.
• Positional tests . A positive Dix-Holpike test confirms the presence of BPPV. Additionally, a rotational test is performed to determine the location of the otolith (in the endolymph, on the cupula) and the localization of the affected semicircular canal.
• Romberg test . It makes it possible to preliminarily establish the location of the pathological focus. “Falling” to one side indicates the presence of an acute vestibular disorder, staggering from side to side with open eyes indicates a lesion of the brainstem and cerebellum, with closed eyes indicates polyneuropathy or involvement of the posterior columns of the spinal cord.

A complete neurological examination is performed to detect neurological deficits. To detect a connection with intoxications, inflammatory and autoimmune diseases, the anamnesis of life is studied. The list of additional examinations for severe dizziness includes:

• Studies of the vestibular analyzer . Along with the Dix-Holpike test and rotational tests, the patient may be prescribed stabilography, video oculography, videonystagmography, and a caloric test.
• Hearing Research . Indicative of damage to the inner ear. A test with tuning forks indicates a bilateral (sometimes asymmetric) deterioration in sound perception. When conducting tone threshold audiometry, there may be a decrease in bone and air conduction.
• echoencephalography. It is used to detect epileptic activity in the temporal leads. Temporal lobe epilepsy is not always recognized on the EEG; in doubtful cases, polysomnography is recommended.
• Magnetic resonance imaging . MRI of the brain can detect dysplasia, cysts, areas of medial temporal sclerosis, and other changes that underlie epilepsy. MRI of the temporal bone is informative when excluding developmental anomalies, neoplasms, injuries and other pathological processes in the area of ​​the inner ear.

Consultation of a neurologist

Treatment

Conservative therapy

The goal is to eliminate or minimize discomfort, correct the disorders that provoke the onset of the symptom. The tactics of treatment is determined depending on the cause and mechanism of development of severe dizziness:

• Pathology of the inner ear . Taking into account the clinical situation, diuretics, antihistamines and vasodilators, anticholinergics, antipsychotics, B and C vitamins, iodine, bromine and calcium preparations are prescribed. With DPPG, training of the vestibular apparatus is indicated. Patients are taught special techniques (Ellie, Simont) to change the position of the otoliths and eliminate unpleasant manifestations.
• Arrhythmias . Complete atrioventricular blockade is stopped by blockers of M-cholinergic receptors. In the interictal period, the underlying disease is treated. NSAIDs, antibacterial, antiviral and antianginal agents, antiplatelet agents, glucocorticoids can be used.
• TIA . Antiaggregants, indirect anticoagulants are shown. Perform hemodilution with dextran, glucose solution, saline solutions. Stabilize blood pressure with antihypertensive drugs. To improve cerebral circulation, cinnarizine and vinpocetine are prescribed. Carry out neurometabolic therapy.
• Temporal epilepsy . To reduce the frequency of seizures and achieve a state of remission at the initial stage, monotherapy with carbamazepine, barbiturates or valproates is performed. With the ineffectiveness of monotherapy, they switch to the simultaneous use of several drugs.
• Panic attacks . Combinations of drug and non-drug methods are recommended. Patients are referred for psychotherapy, taught to control breathing. As part of drug therapy, long courses of tricyclic and tetracyclic antidepressants are indicated. To reduce the severity of side effects in the first weeks of taking antidepressants, they are combined with benzodiazepines.

Sometimes physiotherapeutic methods are used: electrosleep, oxygen therapy, massage, circular shower, microwave therapy. In diseases of the labyrinth during remission, drug electrophoresis, darsonvalization, ultraviolet irradiation, coniferous and sea baths are effective.

Surgery

The variant of surgical intervention is chosen taking into account the cause of severe dizziness:

• Diseases of the inner ear : tympanotomy with closure of the perilymphatic fistula, pressure reduction in the endolymphatic space by fenestration of the semicircular canal, perforation of the base of the stirrup, drainage, laser destruction of the labyrinth.
• Epilepsy : temporal resection, sometimes amygdalotomy, selective hippocampotomy or focal resection.
• Arrhythmias : installation of a single-chamber or dual-chamber permanent pacemaker.