Dizziness in adults
When dizziness occurs in adults, you need to know exactly its causes. In some cases, they are relatively harmless, in others they are a sign of serious problems that require immediate treatment.

If a person becomes dizzy, they may feel like they are moving or spinning when they are not. Or it may seem to him that the environment, objects are in motion, although this is not so. Many people describe dizziness as lightheadedness and weakness, but this condition is different from dizziness. Simple movements are unusually uncomfortable for people with vertigo, and the condition can affect daily life.

Subjective symptoms are likely to depend on what is causing the seizures and the type of vertigo. There are 2 main types of dizziness1:

Peripheral dizziness. Peripheral vertigo is caused by problems in the inner ear or vestibular nerve, which connects the inner ear and the brain. This is the most common type of dizziness.

Central vertigo. Central vertigo occurs when there is a malfunction in the brain, especially in an area of ​​the brain called the cerebellum.

In addition to the types mentioned above, a new kind of vertigo has recently been discovered. In a study published in June 2018 in the journal Neurology, scientists called it “recurrent spontaneous vertigo with nystagmus causing head shaking” (in English it sounds like an abbreviation of RSV-HSN)2.

To diagnose this condition, participants sat in a dark room while the researcher moved their heads forward and then side to side for about 15 seconds. The researchers then videotaped the participants’ eye movements. The results showed that people with RSV-HSN had eye movements known as nystagmus that lasted longer than people with traditional vertigo.

Compared to other types of vertigo, RSV-HSN includes more severe motion sickness attacks, scientists say. In a study, people with RSV-HSN had seizures that included nausea, vomiting, headaches, and head movement intolerance. They experienced symptoms from several times a week to once a year. At this point, the cause of RSV-HSN is unknown, but the condition seems to respond well to treatment.

What is dizziness

Many people describe dizziness as feeling like the room is spinning. This can cause the person to feel tilted, wobbled, unbalanced, or unsteady. Sometimes these unpleasant sensations are intensified if the person is standing, walking, or moving his head.

Many people describe these feelings as physically exhausting and uncomfortable. Sometimes the sensations are so strong that nausea or vomiting occurs. Symptoms of dizziness usually do not include lightheadedness, fainting, or motion sickness.3.

Causes of dizziness in adults

Dizziness is not a disease. On the contrary, it is a symptom of other diseases. Finding out what is causing a patient’s symptoms is one of the first things a doctor will do when evaluating how to treat dizziness. A person needs to know what causes dizziness before they can treat it. It may be useful to identify specific risk factors and diseases.

Dizziness can be caused by a variety of problems. Some of the more common conditions are known as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and labyrinthitis. Less common causes may include migraines, medications, head injuries, stroke, and others.

As one of the symptoms, dizziness can be caused by about 120 types of diseases with different causes and development mechanisms. Quite often, attacks of dizziness occur as a result of chronic cerebral ischemia (the so-called dyscirculatory encephalopathy – a problem associated with insufficient supply of blood and oxygen to the brain). Dizziness is possible as a result of a stroke, they also occur with epilepsy, tumors in the auditory-vestibular nerve, incorrect selection of antihypertensive therapy, and with many other pathologies.

Dizziness is one of the symptoms of vestibular ataxia. This is a pathology of the nervous system, in which coordination suffers, it is difficult for the patient to maintain the necessary posture. The root of the problem is in the defeat of the vestibular apparatus (both its receptor, conductive part, and the central one). With vestibular ataxia, unsteadiness, instability when walking, sitting and standing are typical. These manifestations are supplemented by dizziness and nystagmus, nausea with vomiting, disorders of autonomic tone are possible.4.

Women with a family member who is dizzy, older than 50, and experiencing high levels of stress may increase their risk of a dizzy spell. Other factors can also increase the chances of developing symptoms. Knowing certain risk factors and managing them can help prevent dizziness.

A special form of dizziness is psychogenic seizures. They occur against the background of anxiety disorders, panic attacks, strong stressful effects. There are no problems in the inner ear or brain. Patients describe subjectively unpleasant sensations caused by emotions, external influences. After the elimination of the influencing factor or the end of the panic attack, these sensations disappear, that is, dizziness has a clear connection with mental arousal.5.

Vertigo symptoms are often the result of problems with the inner ear (vestibular system). The inner ear plays a big role in achieving balance. Inside it is a tiny organ called the vestibular labyrinth, which includes semicircular canals that contain fluids and hair-like sensors. Other structures in the ear, called otolithic organs, help keep track of head movement and position in relation to gravity. They contain small crystals that cause the body to respond to gravity.

Sometimes these crystals can break free and move into the semicircular canals. This can irritate the hair cells inside the canals and make them more sensitive to changes in head position. This fact allows you to send false messages about the position of the body to the brain.

Essentially, inner ear disorders cause the brain to receive signals from the inner ear that are not the same as what the eyes and sensory nerves (the nerves that send messages to the brain) receive.

Symptoms of dizziness in adults

Symptoms of vertigo vary in strength and character for each person. Symptoms can be mild or severe, depending on what is causing the problem.

Some common signs and symptoms of peripheral vertigo include:

  • feeling as if the body is moving or spinning;
  • trouble focusing eyes
  • hearing loss in one ear;
  • balance problems;
  • tinnitus;
  • sweating;
  • nausea or vomiting.

Central vertigo can cause the following signs and symptoms:

  • double vision;
  • difficulty swallowing;
  • paralysis of the facial nerve;
  • eye movement problems;
  • slurred speech;
  • weak limbs.

Treatment of dizziness in adults

Before starting treatment, it is necessary to accurately determine the causes of dizziness, for this you need to contact a neurologist. The doctor conducts an initial examination, the necessary tests and instrumental studies, may involve other specialists in consulting. It can be:

  • otoneurologist, if the problem is related to the inner ear and the vestibular apparatus, the auditory nerve;
  • neurosurgeon – if brain tumor processes, cysts or other neoplasms are suspected;
  • cardiologist – if problems are associated with hypertension, circulatory disorders;
  • psychotherapist – for psychogenic causes of dizziness attacks6.

Diagnostics

Diagnosing dizziness is not always easy. In fact, it can be a complex and lengthy process. This is because people with vertigo often find it difficult to describe their specific symptoms.

First, the doctor will try to find out if the person has “true vertigo” by asking about specific complaints. The focus will then be on diagnosing the cause. A neurologist may ask about family and medical history, conduct a physical examination, and order various tests.

He may perform a maneuver called the Dix Hallpike maneuver to recreate the symptoms of vertigo. If the result is positive, it is a diagnosis of peripheral vertigo.

Sometimes people with vertigo are referred to a specialist doctor, an otoneurologist, who deals with inner ear or balance problems. While the process of diagnosis can sometimes seem tedious, it’s important to stick to a course so that professionals can figure out what’s causing the symptoms.

The group of otoneurological studies includes:

  • vestibulometry;
  • various methods for detecting nystagmus (chaotic eye movement);
  • registration of evoked myogenic potentials;
  • hearing test (tonal threshold audiometry within the extended frequency range);
  • tuning fork tests and acoustic evoked potentials.

To identify the causes of Meniere’s disease, MRI cisternography and selective microvascular decompression of the vestibulo-auditory nerve can be prescribed.

If confirmation of cerebral ischemia due to circulatory disorders is needed, assessment of cerebral blood flow using adaptive 3D CT perfusion may be indicated.

For patients with complex pathologies, complex laboratory diagnostics is prescribed, duplex ultrasound of blood vessels, Holter monitoring, ABPM, MRI of the brain, and MR angiography (venosinusography) are performed.

Modern treatments

There are several treatment options available to help relieve the symptoms of dizziness.

If the attack occurred for the first time, it is quite severe, the patient is hospitalized in a hospital, where urgent measures are taken to eliminate discomfort. To do this, follow the following recommendations.

Keep calm, do not make sudden movements, turns.

Apply antiemetic drugs and drugs that suppress the activity of the vestibular system, tranquilizers. They can be used in the acute phase, no more than 3 days.

As the condition improves, physical rehabilitation is necessary, which includes special types of gymnastics (vestibular) with exercises for the head and eyes, and gait correction methods. This helps to eliminate peripheral forms of pathology, and in the central one – to adapt to ongoing processes.

For benign positional vertigo, the Epley Maneuver, a popular therapy that involves moving crystals into the inner ear, has up to a 90% success rate in helping people with the most common cause of vertigo. An alternative is the Semont or Lempert maneuvers, Goufoni, deep tilting of the head.

With persistent changes, the patient is recommended to perform Brandt-Daroff gymnastics at home until all symptoms disappear.

During rehabilitation, physiotherapy is indicated. Can be applied:

  • balance therapy with BFB (biofeedback), during which the patient retrains his body to coordinate the work of organs and systems, to maintain balance;
  • therapeutic massage aimed at combating stress and related problems;
  • VLOK;
  • hirudotherapy;
  • OMT (magnetoturbotron);
  • laser therapy;
  • program of individual cognitive rehabilitation.

Sometimes medications, injections, psychotherapy, or surgery are needed. The doctor will determine which options are best for the individual patient. You don’t have to live with the discomfort of dizziness. In most cases, treatment can help control or eliminate symptoms so that a person can enjoy daily activities.

Some medications used to treat symptoms of dizziness include:

  • Dramamine (dimenhydrinate);
  • Antivert (meclizine);
  • Valium (diazepam).

What a person eats can also affect the general condition. Many people report that changing their diet and avoiding salty, sugary, or caffeinated foods has improved symptoms.

Staying hydrated is another way to combat dizziness.

Dietary supplements such as ginkgo biloba extract are also used as ways to relieve symptoms. But there is no conclusive evidence in favor of supplements.

In addition, acupuncture, yoga, meditation, exercise, and adequate sleep can help prevent a vertigo attack. Talk to your doctor before using any home remedies.

Prevention of dizziness in adults at home

In most cases, dizziness cannot be prevented. But some cases of vertigo are due to head injuries, so it’s important to protect your head by wearing a helmet while cycling or playing sports, or by taking steps to prevent falls.

Popular questions and answers

Answered questions about dizziness neurologist at the clinic “Neplacebo”, teacher of neurology Elena Gayvoronskaya.

What are the complications of dizziness?

Dizziness can occur with diseases of the nervous system, pathology of the heart and blood vessels, ENT problems, mental disorders. The doctor evaluates the characteristics of dizziness, on the basis of which he makes a diagnosis.

For example, attacks of severe dizziness that occur when turning the head, when there is a feeling that objects are spinning (“like on a carousel”, “like a helicopter”), lasting up to a minute, most often speak of benign paroxysmal positional vertigo (BPPV). A persistent feeling of unsteadiness (“as if drunk”, “foggy head”) that increases with walking and decreases at rest may indicate persistent postural-perceptual vertigo (PPPV).

When to call a doctor at home for dizziness?

If severe dizziness occurs suddenly and is accompanied by muscle weakness in the arm and leg on one side, numbness in half of the face and body, impaired speech, swallowing, facial distortion, double vision, loss of consciousness, which occurs for the first time in life with a very severe headache, it is necessary see a doctor immediately to rule out a stroke.

Is it possible to treat dizziness with folk remedies?

Many people are interested in how to treat dizziness, but there is no universal answer to this question. Dizziness has dozens of causes, treatment depends on what disease each individual patient has. But folk remedies should not be practiced unless a doctor advises them.

Sources:

  1. Tolmacheva V.A. Causes of dizziness // Neurology, neuropsychiatry, psychosomatics. 2010. No. 4. https://cyberleninka.ru/article/n/prichiny-golovokruzheniya
  2. Lee SU, Choi JY, Kim HJ, Kim JS. Recurrent spontaneous vertigo with interictal headshaking nystagmus. Neurology. 2018 Jun 12;90(24):e2135-e2145. doi: 10.1212/WNL.0000000000005689. Epub 2018 May 23. PMID: 29792303.
  3. Parfenov V. A., Zamergrad M. V., Melnikov O. A. Vertigo. Diagnosis and treatment, common diagnostic errors: a textbook. – 3rd ed. – M .: Medical Information Agency, 2019. – 207 p.
  4. Aptikeyeva N.V., Dolgov A.M. Vestibular vertigo and ataxia in emergency neurology // Neurology, neuropsychiatry, psychosomatics. 2013. No. 4. https://cyberleninka.ru/article/n/vestibulyarnoe-golovokruzhenie-i-ataksiya-v-neotlozhnoy-nevrologii
  5. Dieterich M, Staab JP, Brandt T. Functional (psychogenic) dizziness // Handb Clin. neurol. — 2016. — Vol. 139. — P. 447-468.
  6. Palchun V. T., Kunelskaya N. L., Rothermel E. V. Diagnosis and treatment of benign paroxysmal vertigo // Bulletin of otorhinolaryngologists. – 2007. – No. 1. – S. 4-7.

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