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When the world spins

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When the world spins

Pantherstock

Headache in an older man

Dizziness is a very common population ailment. However, they are not a specific symptom, which poses many diagnostic difficulties. From a clinical point of view, dizziness may be a consequence of pre-existing conditions or pathological processes in the body. Therefore, the cooperation of a team of specialists is very important in order to make an accurate diagnosis and select an effective treatment.

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Table of contents:

  1. Dizziness
  2. Dichotomous division of vertigo
  3. Etiology
  4. Diagnosis
  5. Treatment

Dizzinessis a condition that is quite common in today's population, and its severity and prevalence is directly proportional to age. They can be understood in two ways - either as a sense of movement of the environment, referred to as an illusion or delusion, or as a sense of instability and postural uncertainty. i.e. a sense of imbalance. The cause of this type of sensation lies in the vestibular system, known as the balance system, the structure of which consists of components such as the vestibule, as the primary organ of balance, its peripheral innervation, as well as centres in the brainstem, cerebellum and cerebral cortex [1].

Dizziness

Damage to one of the components of the vestibular system may be the cause of the unpleasant sensations experienced during dizziness, and damage to the vestibular system itself as well as to its innervation may be equally responsible for such discomfort. Thus, a distinction can be made between vestibular vertigo and extra-vestibular vertigo, which is clinically crucial - vestibular vertigo is the domain of ENT, while extra-vestibular vertigo (associated with peripheral nerve damage) is the subject of research and consideration in neurology [1].

According to the definition, when vertigo is referred to, it also refers to the illusion or delusion of either movement of the environment or instability of one's own body through sensations such as spinning. However, this is a situation in which the person experiencing this type of phenomenon himself is fully aware that the environment, which appears to be 'spinning', is in fact stable, hence there can be no hallucination, and the term 'illusion' is used [1].

Dichotomous division of vertigo

Almost 100 years ago, the division adopted by Edward Hitizg, a German psychiatrist, who divided vertigo into two categories, entered clinical practice. One was associated with a sense of movement of the surroundings, with the illusion that the surroundings were moving - referred to at the time as systemic vertigo. The second category referred precisely to a feeling of instability in one's own body, with a feeling of imbalance, which he referred to as non-systemic dizziness. To this day, this subdivision remains in force with a slightly more refined nomenclature [1].

Etiology

Dizziness itself can be described in different ways and from an equal point of view - aetiology, pathogenesis or medical practice. The same can be said of the causes of dizziness, of which there is a whole range. Focusing on the literature on the subject, it is noted that for a very long time it was thought that a phenomenon such as dizziness was symptomatic and due to another cause - a consequence of something: another condition. However, recent times have brought more and more reports and descriptions of so-called idiopathic or spontaneous dizziness. Nevertheless, dizziness is a non-specific ailment with a wide variety of causes, including infections, all kinds of pathologies and vascular disorders, intoxications, various types of trauma, but also ongoing neoplastic or immunological processes in the body [1]. From this point of view, therefore, it can be said that a patient presenting to a doctor with dizziness presents a diagnostic challenge, and a correct diagnosis and determination of the cause of the complaint is usually not possible during the first medical visit. An additional difficulty is the frequent spontaneous appearance of dizziness and its disappearance, which sometimes makes it impossible to make a correct diagnosis even after several years of observation and diagnosis of the patient [2].

Damage-error, Disorders-of-the-balance-system, Dizziness, Imbalances, Peripheral nerve damageDizziness, photo: panthermedia

Various types of medical conditions can be the cause of dizziness, and some of these are sometimes not minor conditions. Migraine has been shown to be important in clinical studies, so much so that the category of migraine dizziness has been distinguished [3].

Diagnostics

The role of the general practitioner is immense during the diagnostic procedure, but the expertise available to them is often not sufficient to accurately identify the source of the problem and make an accurate diagnosis. It is very important to take a thorough history with the patient, as this helps to exclude general causes of complaints related to disequilibrium and dizziness. These include conditions such as diabetes, cardiovascular disorders,kidney disease or poisoning (with particular attention to drug poisoning). Information relating to the social and living conditions in which the patient lives is also important. This may be related to malnutrition, habits or addictions, or relationships within the family and chronic stress that the patient may be experiencing.

Referral to specialists is therefore crucial to get to the root of the problem - vagus or nerve damage. Both an ENT specialist and a neurology specialist should lean on the case [2].

The diagnostic process itself is therefore based on the cooperation of a team of specialists, with the main aims of helping (usually in a hospital setting) those who require emergency care, assessing which part of the vestibular system is damaged (peripheral or central), and identifying the cause of the pathology present in order to implement the appropriate treatment for the patient [2].

Treatment

Therapy in vertigo, depending on its cause, can take a variety of forms. It can be of an ad hoc nature, which aims to remove or alleviate, the symptoms that are dizziness through symptomatic therapeutic management. Another solution is causal therapy, which is the action of treating the condition causing the dizziness, but here it is necessary to refer primarily to a correctly made diagnosis and diagnosis. Still another type of treatment is the implementation of rehabilitation, the main aim of which is to eliminate the consequences of damage to the balance system [1].