Vestibular disorder
The causes and mechanisms that cause dizziness in neurological diseases are not fully understood. Discussions continue to this day in medical scientific circles, and this despite the fact that in neurology, the most modern diagnostic methods are used to examine the structures of the brain and inner ear. Conventional drug therapy, which includes the use of sedatives, does not always have the desired effect, and in the case of long-term use, it can even have a negative impact on the processes of compensation of the functions of the vestibular system and the patient’s recovery. Vestibular disorders, manifested in vascular pathologies of the head, are the leaders among all vestibular manifestations known to medicine.
Vestibulopathy: what is it?
The syndrome is characterized by the following symptoms:
- Dizziness. Rotating objects that are around a person, or spinning one's own body.
- Balance imbalance. It becomes difficult for a person to walk, he is unable to move smoothly.
- Headache. It manifests itself individually in everyone - from minor pressing to continuous “breaking”.
- Visual impairment. Spots or “floaters” periodically appear before the eyes, and the sharpness is temporarily reduced.
- Nystagmus. The eyes move rhythmically and uncontrollably in one direction - horizontally, vertically, in a circle.
- Hearing problems. Noise or ringing in the ears, hearing loss.
- Digestive disorders. Vomiting and persistent nausea.
What diseases cause vestibular disorders?
Vestibular disorders have the following causes:
1. People aged 60 years and older often experience benign positional vertigo, which occurs against the background of traumatic brain injury, otitis media, and ischemia. However, there are cases where the exact reasons were not established.
This vestibular disorder is characterized by the following symptoms and external signs: a person changes his body position in bed (lays down, stands up, turns around), and he experiences a short-term attack of dizziness. In most patients, the exacerbation phase (attacks of dizziness occur quite often) is replaced by a spontaneous long-term remission.
To confirm the diagnosis, special so-called positional tests are used - the person changes the position of the head, and doctors record when nystagmus and dizziness occur.
The appearance of this disease is facilitated by the formation of otoliths in the posterior semicircular canal. The force of gravity acts on the otoliths, and they shift, irritating the vestibular receptors of the dome, which leads to dizziness. This condition can last for a very long time without the manifestation of any other disorders.
Treatment of this vestibular disorder with traditional medications often does not produce the desired effect. In cases where the body is particularly resistant to certain medications, surgical intervention is indicated. Severe outbreaks of positional vertigo have another cause - the loop of the anterior inferior cerebellar artery compresses the vestibular nerve, which leads to decreased hearing sensitivity, tinnitus and hyperacusis. Taking carbamazepine (finlepsin) usually helps to relieve the manifestations of this disease, and in cases of ineffectiveness of the drug, a procedure such as microvascular decompression of the nerve is used. Drinking alcohol leads to changes in endolymph density, and this can also cause dizziness.
2. Another fairly well-known cause of dizziness is vestibular neuritis. It is caused by damage to the vestibular nerve or peripheral vestibular apparatus. People of all ages are susceptible to the disease. It is often preceded by infectious diseases affecting the upper respiratory tract. In this case, the following symptoms of the disease and its external signs are distinguished: sudden rotational movements of the head cause an attack of dizziness, vomiting, and a feeling of nausea. The presence of horizontal rotatory nystagmus is observed. An important fact is that in the case of this disease, the nystagmus has only a unilateral direction, while in the case of a bilateral one, we are talking about a different diagnosis. Vestibular neuritis is characterized by the absence of other neurological symptoms (for example, decreased hearing sensitivity). Attacks of severe dizziness, accompanied by repeated vomiting, last in the patient for 3-4 days, but complete remission occurs only after a few weeks. In cases where the patient’s condition does not improve within a month, he is sent to magnetic resonance or computed tomography for additional research. Mild cases of the disease do not require hospitalization; outpatient treatment is quite possible. At the initial stage, short-term treatment with corticosteroids is often prescribed - they reduce vestibular symptoms. The positive effect and improvement in the patient’s condition provide grounds for discontinuing medications and prescribing special exercises to strengthen the vestibular apparatus.
3. The root cause of vestibular disorders in older people with a history of vascular diseases is often vertebrobasilar insufficiency. It can be caused by pathologies such as ischemia of the labyrinth or vestibular nerve or trunk. This vestibular disorder is characterized by the acute development of an attack of dizziness, the presence of disturbances in the functioning of the vestibular system, vomiting, and a feeling of nausea. In some cases of ischemia of adjacent sections of the trunk, other external signs are observed - a person may suddenly fall, he is disoriented, his vision is impaired, his limbs become flaccid and numb.
The occurrence of vertebrobasilar insufficiency can also be caused by some other reasons: atherosclerosis of the arteries, sometimes cardiogenic embolism, increased blood viscosity, vasculitis. To accurately diagnose this disease, it is necessary to take into account the symptoms of various concomitant diseases in the medical history, namely arterial hypertension (high blood pressure), diabetes mellitus, hyperlipidemia. The entire course of treatment for vertebrobasilar insufficiency is primarily aimed at correcting or eliminating risk factors, and includes taking antiplatelet and vasoactive drugs.
4. Blockage of the internal auditory artery is one of the most persistent types of vertigo. The most common external sign of this disease is hearing loss. Cerebellar ataxia and nystagmus, coupled with an acute attack of dizziness, may indicate hemorrhage or cerebellar infarction. And in these cases, emergency intervention is required, since we are talking about human life and death. The initial stage of cerebellar stroke is very similar to vestibular neuritis. And they differ in nystagmus, which in this disorder is bilateral or vertical. The patient is also unable to stand without assistance.
5. Slowly increasing imbalance and moderate dizziness indicate chronic bilateral vestibulopathy. The cause of the disease can be intoxication of the body with certain types of medications. Timely discontinuation of the medication helps restore vestibular function. If this is not done in time, the process becomes irreversible. Various types of solvents, chemicals, and loop diuretins can also sometimes cause a vestibular disorder called chronic vestibulopathy.
6. Here are the known symptoms of Meniere's Disease: dizziness that occurs occasionally, congestion and tinnitus, accompanied by a decrease in hearing sensitivity. An acute attack of dizziness reaches its maximum in a few minutes and regresses in the following hours. At the very beginning of the disease, the process of hearing loss can be stopped. But each subsequent attack leads to the fact that hearing sensitivity becomes lower and lower. In this case, constant tinnitus appears, which intensifies before the onset of an attack and during it. Some patients may fall suddenly without losing consciousness. The reason for this is a sharp increase in pressure in the inner ear and, as a result, irritation of the vestibular receptors. In the process of diagnosing this vestibular disorder, the main condition is the exclusion of other diseases, for example, SLE, neurosyphilis or hypothyroidism.
7. Injuries to the skull and head can often become a source of post-traumatic vertigo. This occurs due to concussion of the labyrinth, the formation of a perilymphatic fistula, or a violation of the integrity of the temporal bone.
8. There are a number of other ear diseases that can cause vestibular disorders. These include: common wax plugs in the ears, Eustachian tube dysfunction, otosclerosis. Otitis media in acute form can also cause dizziness, especially if it is complicated by purulent processes in the labyrinth.
9. One of the rather rare and infrequent causes of dizziness is a tumor of the cerebellopontine angle. A gradual and slow process of hearing loss, as well as constant tinnitus, indicate a disease such as acoustic neuroma.
10. Let us note another cause of vestibular disorders - basilar migraine. Girls in the prepubertal period are most susceptible to migraine dizziness and pain. They last no more than an hour and are relieved by taking anti-migraine medications.
11. Short-term attacks of dizziness can also occur with epilepsy. But along with them, other symptoms of an epileptic seizure are usually observed: motor, autonomic or sensory, and a disturbance of consciousness is necessarily present.
12. Craniovertebral anomaly - we are talking about it when attacks of dizziness are combined with nystagmus and impaired speech and swallowing functions. Symptoms such as vomiting, nausea, dizziness with rotational movements of the head can signal the initial stage of multiple sclerosis.
Etiology and pathogenesis
The cause of short-term and frequent attacks of dizziness is considered to be compression of the nerve by the vessel.
The aberrant arteries of the cerebellopontine angle, due to elongation and expansion as a result of their damage by atherosclerosis, pulsate strongly and thereby compress the prevestocochlear nerve and cause focal demyelination.
Symptoms arise as a result of either pathological paroxysmal signal transmission between adjacent axons.
There is also a hypothesis about hyperactivity in the nuclei of the prevestocochlear nerve, which develops as a result of compression of the nerve.
In addition to the elongation and tortuosity of the vessel, there may be an aneurysm and malformation of the arteries of the posterior cranial fossa.
Nerve tension due to arachnoid cyst.
Differential diagnosis:
- benign paroxysmal positional vertigo
- Meniere's disease
- paroxysmal brainstem syndromes
- vestibular migraine
- phobic postural vertigo
- occlusion of the vertebral artery when turning the head.
Diagnostic examination plan:
- consultation with an audiologist (audiometry + impedance measurement)
- consultation with a neurologist
- MRI with contrast
- Ultrasound of blood vessels + functional tests
- Videonystagmography
Which doctors should I contact if a vestibular disorder occurs?
If you notice disturbances in your vestibular state, you should definitely seek advice from a specialist - a neurologist. Based on certain symptoms and external signs, only a doctor can make an accurate diagnosis. Therefore, if you find signs of a neurological disease, seek help from a neurologist. Do not put your health at risk - do not self-medicate.
Primary appointment with a neurologist: 1850 RUR.
Sign up Online 5% discount when registering from the site
