Vertigo

The Vertigo (from the Latin for revolution, dizziness; vertere of contact ) is the medical term for dizziness. The corresponding adjective is vertiginös ( " dizzy ").

Under dizziness in the medical sense is defined as the perception of a rotating or swaying feeling or the feeling of impending loss of consciousness. Defines is dizziness in the medical sense as a perceived apparent motion between itself and the environment. A distinction is made, inter alia, turning, Schwank, lift, movement and unsystematic dizziness. In addition, symptoms of poor circulation are often called vertigo.

In German the term is therefore used for different phenomena. In English, in contrast, vertigo (dizziness ), and dizziness ( dizziness feeling) can be distinguished.

Epidemiology

Although dizziness is very common, there are few studies on the epidemiology. Colledge et al. indicate that 30% of over-65s in the last year were suffering from dizziness at least once a month. Yardley et al. found in 20% of 18 - to 64 -year-olds at least once per month dizziness. Sandholzer et al. examined patients of general practices with an average age of 76 years who reported 50% of whom dizziness as a symptom.

Kroenke indicates that about 20 % of dizzy patients in general practice a somatic cause is detectable. At about 15 % must be assumed psychogenic causes. The remaining two -thirds no diagnosis can be made.

Dizziness types

Dizziness can have many different complex causes. During the investigation, it is helpful to classify the dizziness in the four types of dizziness to narrow down the possible causes.

• Vertigo: The patient feels like a carousel, it occurred illusory movements ( oscillopsia ) on. The causes are usually vestibular here, but sometimes also in the CNS.

• Seconds Vertigo: The patient has the feeling of being powerless. When this happens all of a sudden, you have to draw bradycardic arrhythmias and a sensitive carotid sinus into consideration. In prodromal symptoms, you should think of orthostatic tachycardia and arrhythmias.

• Space uncertainty: Patients indicate a funny feeling in my head. This is either nachschwankend and can only be triggered by head movements (CNS, eyes, vestibular, benign positional vertigo ), or continuously available (Psyche, CNS, medications, hyperventilation).

• Speed ​​uncertainty: This is not dependent on head position or head movements, the head is free. Can be the cause of this kind of fraud, if any, by movements of the body. Can cause the peripheral nervous system, CNS, eyes, or of the psyche are.

Causes of Vertigo

Dizziness often arises from conflicting information from participating in the equilibrium sense of sense organs such as eyes, balance organs of the inner ear as well as muscle and joint receptors. Dizziness is one of the most common consultation events in a general medical practice.

The vestibular organ in the inner ear is a sense for rotary and linear acceleration and closely connected with reflections.

A linear acceleration is recorded in the standing in the horizontal and the vertical plane of the utricle and saccule macula. The sensory hairs of these receptors are in a so -called otoliths by crystal grains, matrix embedded complained. During acceleration in the plane of the macula this remains due to its inertia, resulting in a deflection of the sense of the hair. Due to the acceleration due to gravity can be determined in the room with these receptors, the position of the head.

Spins ( rotational motions ) are registered by sensory hairs in the semicircular canals - three interconnected, mutually perpendicular, each annular vessels that are filled with lymph fluid. In a rotary motion in the plane of each semicircular canal, the lymph fluid remains at rest because of their inertness to the moving bones of the skull. Thus, the sensory hairs in the semicircular canals, which join the rotation, deflected by the fluid at rest.

If symptoms persist, rotational movements occur by friction to a concomitant movement of lymph. If portico and lymph moving at the same speed, reduces the sensory stimulus and eventually goes to zero. There will be a habit. With cessation of rotation, the liquid rotates further and gives the impression of an opposite rotation forth. The reflex response can not be suppressed, even if the eye is the true motion. The contradiction of the senses creates confusion or disorientation. Pilots must therefore learn the instrument flight, the display of navigation devices to be trusted more than their sensory impressions.

Disorders of the vestibular system (peripheral: inner ear balance nerve; central: brainstem cerebellum cerebrum ) can be the cause of dizziness sensations: vestibular vertigo. Often dizziness is accompanied by vegetative body reactions such as nausea, vomiting, sweating, heart acceleration and collapse.

Examples ( of frequency):

• Benign paroxysmal positional vertigo, benign positional vertigo
• Diseases of the inner ear ( vestibulopathy )
• Menière's disease
• Inflammation of the organs of balance ( vestibular neuritis )
• Circulatory disorders ( cerebellar infarction ), tumors ( acoustic neuroma ), mechanical damage ( traumatic maze loss in temporal bone fracture ), etc. with the involvement of the vestibular system
• Basilar migraine - a migraine - associated vertigo, also known as Bickerstaff syndrome or basilar migraine referred
• Basilariskompressionen by rotational or translational subluxation in the head joint at head joint instability, for example, as a result of a whiplash injury with soft tissue injury
• Bogengangsdehiszenz, a bone defect in the inner ear, which can lead to autophony, dizziness, Tullio phenomenon and hearing loss

For non -vestibular dizziness a variety of other causes are described, including precursors of fainting (pre- syncope) with hypotension ( low blood pressure ), heart rhythm disorders, and probably blocks the cervical vertebrae ( vertebral vertigo), and epileptic discharges in the posterior portions of the gyrus superior temporal be epileptica in Vertigo.

Scuba divers sometimes experience a vertigo when cool water penetrates too deeply into the ear. In this case, it helps to orient themselves to the air bubbles, as they rise toward the top. The dive should immediately - be terminated - in compliance with the ascent rate.

When looking from a great height Vertigo can also occur. This helps sticking to stationary objects.

Cervical spine and dizziness

Injury to the joint between the head and cervical spine as a cause of vertigo, especially after whiplash injuries, exemplary and archetypal. As a result of physically designated as whiplash motion injury that occurs preferably at whiplash, a head joint instability may exist. A head joint instability caused by rupture or overstretching ligamentous structures in the skull base (C0 ) to the second cervical vertebra (axis, C2). Violations of Alarligamente, particularly with concomitant rupture of the joint capsule can be an unwanted abnormal motion, translational motion or unilateral injury to a so-called rotatory subluxation between the first two cervical vertebrae ( the atlas and axis ). This can cause an intermittent basilar impression with typical brainstem symptoms. Characterized by diffuse hypoxic damage in Vertebralisstromgebiet ( supply area of ​​the basilar artery ) of the brain ( Okzipitalhirn ) are dizziness, Vigilanzstörungen ( from mild dizziness of mild clouding of consciousness to pronounced somnolence) and blurred vision. Head joint instability almost always go hand in hand with a strong vertigo.

Mental illness and dizziness

Dizziness symptoms often occur in the context of mental illness. It can be (so-called psychogenic dizziness) as well as a cause of mental illness dizziness both a consequence. Both diseases can also occur comorbid. Various studies have shown that 20-50 % of patients dizziness mental illness had a significant influence on the course of the disease.

Mental illness, which often dizziness occur are esp. depression, anxiety disorders and somatoform disorders. In addition, there may be secondary somatoform dizziness, phobic postural vertigo (English phobic postural vertigo ), acute stress reactions come and adjustment disorders.

Studies of dizziness

For clarification of vertigo patients often need to be examined by several specialists. If the primary care physician ( family medicine, internal medicine), the classification can not meet sufficient Specialists in ENT, orthopedics and neurology should be consulted. Under certain circumstances, cardiac and psychiatric examinations are useful.

The following test methods are applied:

• Always: Anamnesis ( Medical history )
• Physical examination Blood pressure, heart rate ( ECG then possibly write )
• Study of eye movements ( nystagmus)
• Equilibrium test hearing test
• Coordination Review
• Unterberger - Tretversuch
• Romberg test

• Hearing test ( audiometry )
• Equilibrium test ( Vestibularistest )
• Electronystagmography ( for the objective evaluation of the oculomotor and vestibular system )
• Occasionally imaging ( CT, MRI)
• Rarely Doppler / duplex sonography, EEG or EPs