Dizziness prof. Dr. Andreas hufnagel

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Origin of dizziness

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The processes in the inner ear

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Example treatment dizziness

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How dizziness occurs?

Dizziness always occurs when the information of the vision, the balance from the vestibular organ and the sense of position do not fit together.

vertigo prof. dr. andreas hufnagel

Figure: Illustration of the arcuate ducts of the vestibular organ in the inner ear (right)

What are the causes of dizziness?

There are many causes of dizziness and many different forms of dizziness. In addition to diseases of the vestibular organ in the inner ear, brain diseases such as z.B. Strokes or brain tumors or diseases of a vestibular nerve, spinal cord diseases or polyneuropathy can also be responsible for the development of vertigo.

Psychological causes lead to the experience of vertigo or panic attacks in phobic vertigo (anxiety vertigo).

Ultimately, internal conditions such as.B. Cardiac arrhythmias, thyroid dysfunction, vascular occlusions in the arteries leading to the brain, hypertension that is too low or very high, or even kidney disease cause dizziness.

Each individual medication taken should be checked to see if it is a possible cause of the dizziness. Many medications can cause dizziness as a side effect. These include in particular antihypertensives, psychotropic drugs and painkillers.

Who is affected by vertigo?

Vertigo is very common overall. About 30% of all people suffer from dizziness at least once in the course of their lives. Dizziness is more common in old age than in youth.

What are the symptoms of vertigo?

Vertigo can be referred to as spinning, staggering or elevation vertigo. If it cannot be classified in this form, it is called diffuse vertigo. It is also important whether it is attack vertigo or permanent vertigo. Vision may be blurred during dizziness. In the case of prolonged dizziness, nausea and vomiting may also occur. In some forms of vertigo, there is a tendency to fall or a gait deviation to one side or in all directions. Some forms of dizziness can develop suddenly within minutes – others gradually over days and weeks. Finally, some forms of vertigo can be provoked or exacerbated by certain positions or movements and others are independent of them. Severe vertigo is accompanied by anxiety. Anxiety can further exacerbate the vertigo experience or become a problem itself.

What are the disorders of vertigo?

The most important 5 forms of vertigo are discussed below:

1. Central vertigo or bilateral disease of the vestibular organ (bilateral vestibulopathy)

This form of vertigo was caused by a disease or decreasing function of both vestibular organs. This is common to some extent in old age and thus part of the aging process. Vertigo does not occur at rest but only when moving the head or when standing or walking. In contrast, there is no dizziness when lying or sitting down. This phenomenon can be explained by the fact that the "computer brain" cannot process the 3 components that contribute to balance, i.e. information from vision, position sensation from the muscles and joints and the equilibrium organs, sufficiently quickly. The processing speed of the information is sufficient at rest and no dizziness occurs. A similar problem occurs when not the vestibular organ but the brain as a whole is diseased, for example in the context of strokes, microangiopathy (strokes of the smallest brain vessels) or reduction of brain volume (brain atrophy). Medication does not help here. However, improvement can be achieved by continuous equilibrium-. can be induced by gait training.

2. Benign paroxysmal positional vertigo (Benign paroxysmal positional vertigo):

Benign positional vertigo is the most common form of vertigo. Older people are affected more often than younger people. About 2,5 % of the population suffer from this dizziness at least for a certain period of time. It is characterized by a spinning dizziness with certain movements of the head or body for a duration of ca. 5 to 60 s. Dizziness is often triggered when the head is turned to the right or left while lying down. There are usually a few seconds between the turning of the head and the onset of vertigo. A ringing in the ears or a change in hearing is absent. Since the duration of the vertigo is quite short, there is usually no nausea or vomiting. Anxiety may be associated. This form of vertigo involves the formation of crystals (or small granules) in the arcades of the vestibular organ in the inner ear. These lead to an increased stimulus, which is answered by a reflex with jerky eye movements. This results in the experience of rotary vertigo for the affected person. In 90 % of all cases, benign positional vertigo develops by itself. In 10%, it occurs after an accident or prolonged bed rest or in the context of another condition such as z.B. an inflammation of the vestibular nerve or an M. Meniere. Positioning exercises are particularly suitable for the therapy of benign positional vertigo. Medications help, if at all, only in the initial phase and should be avoided if possible.

3. Inflammation of the vestibular nerve (neuritis vestibularis)

Similar to a hearing loss, the vestibular nerve can also suddenly fail, leading to violent prolonged spinning vertigo with a tendency to fall, gait abnormality, nausea, and vomiting with abrupt onset. The dizziness often reaches a peak within a few hours to 1-2 days. then gradually subsides over 1-2 weeks. Mild symptoms of vertigo may persist for some time. The cause of this vertigo is an inflammation of the vestibular nerve (8). cranial nerve). The starting point of the inflammation is most likely a virus (most likely herpes virus), although this has not been definitively proven. Treatment is based on the administration of anti-dizziness drugs. Physiotherapy (physical therapy) should be applied immediately after the severe vertigo has subsided, i.e. after only a few days. This leads to a recalibration of the vestibular system. Compensatory (balancing) mechanisms in the brain supported.

4. Meniere's disease

In Meniere's disease, attack vertigo occurs. Emerge out of the blue z.T. very violent spinning vertigo attacks with nausea, vomiting and anxiety. Many patients experience a sensation of ear prere on the affected side prior to an attack. Attacks peak within a few minutes. Completely resolve within 5 min to several hours. However, many patients increasingly develop a fear of the next dizziness attack even between attacks. Responsible for the attack is a buildup of fluid (endolymph) in the vestibular organ. If the prere is high enough, a membrane is ruptured and the prere is equalized. This triggers the vertigo attack. During the attack, hearing on the affected side may be diminished. Increasingly, there is usually a progressive permanent hearing loss. Tinnitus often develops as well. About 20% of patients are bds. Affected. A scientifically proven therapy, which can help the M. Meniere stops or even improves there is not. Treatment recommendations include high-salt diet or dehydrating agents. Several different drugs can alleviate the symptoms. Further therapeutic measures aim at the elimination of the organ of equilibrium in advanced stages by medication or surgery. Over the years, most patients experience a decrease in attack frequency and intensity

In the neurological practice of Prof. Dr. A. Hufnagel has treated more than 15 patients with Opton deep laser so far. The majority of patients reported a significant improvement in the frequency and intensity of their attacks and, in several cases, a complete disappearance of the attacks.

5. Phobic or. Mental vertigo

Phobic vertigo is the second most common form of vertigo in Germany. It often occurs in anxiety disorders or panic attacks. Is also associated with depression. 70 % are affected for months and years and are restricted in their professional activities or private quality of life. Patients often describe a staggering or diffuse dizziness but at the same time also a feeling of lightheadedness or emptiness in the head, uncertainty when walking or the feeling of falling. Nausea is also reported sporadically. Vomiting described. Associated may be impaired concentration and drive, decreased performance, and other symptoms such as: Palpitations, nausea, sweating, fear of suffocation and shortness of breath, weight loss and lack of appetite, mood swings, sleep disturbances and diffuse anxiety may be indicated. In many patients, the vertigo occurs in triggering situations, such as a sudden onset of a dizzy spell.B. When driving a car, when crossing bridges, in the presence of large crowds in a department store or restaurant, in certain situations such as conferences or in confined spaces. Stress at work or in personal life may exacerbate phobic vertigo. In the course, there may be an expansion of the triggering situations with pronounced avoidance behavior. Phobic vertigo may result from another vertigo condition, such as z.B. originate from an expired inflammation of the vestibular nerve or a benign positional vertigo. An attack-like worsening is common. Finally, phobic vertigo may occur without any identifiable triggers. The phobic vertigo is often recognized late. Mostly treated adequately even later (after years). Misdiagnosis is common. Therapy includes anxiety-relieving medication in the initial phase or antidepressants, behavioral psychotherapy, and physical therapy anti-dizziness training. The prognosis is overall rather favorable. However, the treatment can be lengthy. About 75 % become symptom-free after several years.

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6. Rare forms of vertigo

In addition to the forms of vertigo described above, there are other, rarer types of vertigo such as z.B. Vertigo as a form of migraine or in congenital. Genetic disorders. To describe these here would lead too far. If a rare form of vertigo is suspected, an examination by a specialized neurologist should take place to make the diagnosis.

What medications help with dizziness?

All in all it has to be said that medication against vertigo often helps only to a small extent and mostly only in the acute phase of a vertigo attack. Then should be discontinued in order not to stand in the way of a recalibration of the vestibular system. The corresponding medications are described above for the individual forms of vertigo.

Which specialist treats vertigo?

To establish the exact diagnosis of the present vertigo falls into the field of expertise of the neurologist and the otolaryngologist, and in the case of phobic vertigo, also into the field of the psychiatrist. Dizziness in cardiac arrhythmias should be clarified internally/cardiologically.

How to best diagnose dizziness?

It is always necessary to be examined by a neurologist or otolaryngologist and, if necessary, also by cardiologists and psychiatrists. In the field of neurology, it is necessary to perform an EEG, visualization of the auditory pathway (AEP), measurement of blood flow in the brain with ultrasound, provocation tests and magnetic resonance imaging of the head. In the ENT medical field falls the examination of hearing and the examination of the organs of equilibrium by caloric stimulation (rinsing with warm and cold water). Both disciplines can perform electronystagmography (recording of eye movement under certain provocation conditions). An ECG should always be derived. In case of rhythm disturbances a cardiologist should be involved. Only in rare exceptional cases is vertigo associated with cervical spine disease.

What is the best treatment for vertigo? The best treatment results are achieved through physiotherapy with a focus on equilibrium-. Gait training can also be achieved with the use of specific positioning exercises. Medications such as betahistine and sulpiride should be used for attack vertigo in the first days of the disease. Specific forms of therapy are possible for individual types of dizziness. Psychotherapy is always indicated if the dizziness has psychiatric causes or has led to psychiatric disturbance. In this case, 25-50 sessions of behavioral psychotherapy are often necessary, or. often sufficient. The prognosis is generally considered to be rather favorable.

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