Introduction
Dizziness (Latin: vertigo) is one of the most common complaints people are confronted with in everyday life. Among other things, this is reflected in the waiting room of the family doctor. Approximately 10% of all family doctor patients give dizziness as a reason for imagining it.
The frequency of vertigo also increases steadily with age. Up to 30% of people over 65 years of age suffer from dizziness at least once a month. Vertigo is only a subform of vertigo besides lift and swindle.
It is characterized by a directional sensation of rotation, which can be either clockwise or counterclockwise. Rotational vertigo can occur in a wide variety of situations and take completely different courses. The mechanisms behind its various causes are complex and partly still unexplained, making effective treatment often difficult.
How is rotary vertigo different from swindling?
Rotational vertigo and swindling denote two different forms of vertigo. For a rough differentiation the anamnesis, i.e. the questioning of the affected person is usually sufficient. A rotary vertigo feels more or less like the vertigo that one feels after an extended merry-go-round ride. The swaying vertigo, on the other hand, can be compared more to the feeling on a ship in a swell. Depending on which type of vertigo the person concerned suffers from, this can indicate different causes, so a distinction between the two forms of vertigo is primarily diagnostically relevant.
Causes
Dizziness is not a disease in itself, but as a sign of illness part of a disturbance of the vestibular system. The actual cause of this disorder may be a number of different clinical pictures, but often the location of the disorder is directly in the organ of equilibrium, the so-called vestibular organ of the inner ear. Three diseases in particular are of utmost importance.
These are listed in order of frequency: In order to understand the cause of benign positional vertigo, one must first look at the structure of the organ of equilibrium, which among other things consists of the three semicircular canals and two blind ending “tubes” (called sacculus and utriculus). The latter contain the so-called otholiths in addition to hair cells, which are also contained in the archways. These are microscopically small crystals that sit on a gelatinous membrane and intensify the fine movements of the surrounding fluid when the head is moved.
The cause of benign postural vertigo is considered by most scientists today to be small detachments of the otholiths, which block an archway and thus cause the typical symptoms. The cause of Menière’s disease is still unexplained today. The background of the neuritis vestibularis is also unexplained.
However, a viral infection of the vestibular nerve is very likely. There is also discussion of a circulatory disorder of the endolymph fluid contained in the archways. There are many other causes of vertigo.
They include, for example, circulatory disorders of cerebellar parts, traumatic injuries of the cervical spine, dizziness associated with migraine, or severe psychological stress and illness.
- The benign paroxysmal positional vertigo
- The Menière’s disease
- Vestibular neuritis (a chronic dysfunction of the organ of equilibrium)
In addition to the causes of rotational vertigo mentioned above, traumatic injuries to the cervical spine can also be a cause of rotational vertigo and dizziness in general. As a result of whiplash trauma, which involves a so-called whiplash movement, the joints between the head and cervical vertebrae can be damaged, resulting in instability of the head joint.
This instability results in an incomplete dislocation (subluxation) between the first two cervical vertebrae and can cause neurological symptoms such as loss of consciousness due to the resulting pressure on parts of the brain. In the vast majority of cases, dizziness then occurs additionally. If the rotational vertigo only occurs when the head is moved, it is highly probable that benign paroxysmal positioning vertigo is present.
A typical example is the occurrence of vertigo during a simple rotation in bed. The dizziness occurs very suddenly and lasts between 20 and 30 seconds. Treatment is usually possible without any problems by having an expert doctor perform one of several positioning maneuvers.Other types of dizziness, however, occur independently of the situation, whether lying down, standing or walking.
This distinguishing feature plays an important role in determining the cause of vertigo. In addition to the purely physical causes, vertigo can also be related to stress and other psychological stress and illnesses and can be both a consequence and a cause of them. The resulting dizziness is called somatoform dizziness and is by no means less serious than a physical cause of vertigo.
In fact, up to 20 percent of all vertigo patients suffer from this form of vertigo. The most important question that first arises is how serious the symptoms are. Treatment should be considered especially if they restrict the affected person in his or her daily activities.
The symptoms of vertigo caused by stress can vary greatly. For example, it can present itself as rotational, swaying or lift vertigo and can last for different lengths of time from patient to patient. A diagnosis of somatoform vertigo is often preceded by a true doctor’s odyssey, so that effective therapy often begins late.
For this reason, a psychological cause of the vertigo should be kept in mind if the visit of different specialists due to a dizziness symptom remains without result. In MS (Multiple Sclerosis), over the course of several years, nerve fibers in the central nervous system (especially in the brain) are increasingly damaged. Typically, symptoms such as impaired vision and chronic exhaustion occur first.
Over time, other symptoms such as disturbances in the regulation of pupil width, pain during eye movement and a deterioration in vision occur. Due to the disturbance of eye movement, acute attacks of rotary vertigo can occur. In addition, gait disorders and a deterioration in coordination can also occur.
Headaches such as tension headaches and migraines can also be a symptom of multiple sclerosis. The various headache symptoms are also often accompanied by unspecific dizziness or vertigo. Migraine is a type of headache that can be accompanied by many different symptoms.
However, dizziness is not one of the typical symptoms of a migraine attack. Although nausea and vomiting may occur, dizziness is rather rare in a “normal” migraine. The situation is different in migraine with cerebellar symptoms. The cerebellum is responsible for the coordination of movements and can therefore lead to loss of balance and dizziness when disorders occur. Various forms of dizziness can occur, such as spinning dizziness, vertigo or even an undirected vertigo.
