HEADKINDING - a distorted perception of the position of one’s body in space with a sensation of the imaginary movement of one’s own body or environment. It can occur with various neurological and somatic diseases. Often dizziness is associated with dysfunction of the vestibular system (vestibular dizziness). It is characterized by a sense of rotation, which is often directed in a certain direction and is accompanied by nausea, vomiting, nystagmus, imbalance (vestibular ataxia). Often vestibular dizziness is provoked by a change in posture (positional dizziness). Dizziness of a different nature occurs with a fainting condition associated with hyperventilation, orthostatic hypotension, heart rhythm disturbance, and also with a hypoglycemic condition resulting from an overdose of insulin or with insulinoma. Usually it manifests itself as a feeling of nausea and "fog" in the head. Similar dizziness is caused by drugs that depress the central nervous system (in particular, tranquilizers and antiepileptic drugs). Patients are often called dizziness and a sense of instability that occurs with sensitive or cerebellar ataxia, a violation of postural reflexes (see Ataxia). Such dizziness is usually not rotational in nature and occurs only in a standing position and while walking. Dizziness is often observed in patients with cervical osteochondrosis (cervicogenic dizziness). Its cause is not so much compression of the vertebral arteries as a change in impulsation from spasmodic cervical muscles and limitation of head mobility. Psychogenic (psychophysiological) dizziness develops in patients with neurosis and personality changes, often against the background of hyperventilation syndrome (see Vegetative dystonia). Such patients usually experience anxiety, depression, traits of an obsessive personality, and autonomic crises . Sometimes psychogenic dizziness occurs in a certain situation, for example, when shopping, traveling in public transport or crossing a bridge, in an empty room or when attending a concert. Such dizziness is usually not rotational in nature, associated with a sensation of instability and, as a rule, intensifies when walking. Treatment includes rational psychotherapy, vestibular exercises, the use of antidepressants.
Benign positional dizziness can occur at any age, but is more often observed after 60 years. Sometimes it is preceded by a traumatic brain injury , inflammatory diseases of the ear, stroke . This condition is characterized by short-term dizziness when changing the position of the body (when getting out of bed, tilting or tilting the head, turning over from side to side). The diagnosis is confirmed using a special positional test, provoking dizziness and nystagmus. The disease is associated with the formation of otoliths in the posterior semicircular canal. Displaced by gravity, otoliths irritate the vestibular receptors of the dome of the semicircular canal and cause paroxysm of dizziness. About a third of patients experience spontaneous remission. In the presence of additional symptoms, it is necessary to exclude other causes of positional dizziness, including a tumor of the posterior cranial fossa. Using a special technique, the doctor, rotating the patient’s head, can move the otolith from the posterior semicircular canal into the insensitive area of the inner ear and thereby make the symptoms disappear. Transient positional dizziness is often observed with alcohol intoxication.Vestibular neuritis is one of the most common causes of dizziness associated with damage to the peripheral vestibular apparatus or vestibular nerve. The disease can be observed at any age. Acute severe rotational dizziness, nausea , repeated vomiting develop. Hearing loss or focal neurological symptoms are not detected. Spontaneous nystagmus, directed to the healthy side, and imbalance with a tendency to fall towards the lesion are characteristic. Severe dizziness with repeated vomiting usually lasts no more than 2-3 days, but full recovery usually occurs within a few weeks or months. In some cases, a history of an upper respiratory tract infection transferred several weeks before the onset of the disease is noted. A short course of corticosteroids sometimes has a beneficial effect. Drugs that reduce dizziness (see table) are used only in the first few days. In the future, the basis of treatment becomes vestibular gymnastics. Coordinated movements of the eyeballs, head, torso, which the patient first performs lying down, then sitting, standing, and, finally, during movement contribute to reconfiguration of the vestibular system and accelerate recovery.
Post-traumatic dizziness develops after a traumatic brain injury, accompanied by concussion of the labyrinth (often occurs when a blow to the back of the head or behind the ear) or a fracture of the temporal bone. If dizziness occurs due to traumatic brain injury or a sharp drop in air pressure and intensifies with sneezing and straining, perilymphatic fistula should be excluded. Sometimes the cause of dizziness is another pathology of the inner ear - sulfur plug, dysfunction of the auditory (Eustachian) tube, otosclerosis.
Vertebrobasilar insufficiency is a common cause of dizziness in elderly patients. The cause of dizziness is ischemia of the labyrinth, vestibular nerve or brain stem. Dizziness begins acutely, lasts several minutes and is often accompanied by nausea, vomiting, imbalance. Ischemia of adjacent sections of the trunk usually causes additional symptoms: impaired vision, double vision, dysarthria, falls , weakness and numbness in the limbs. Vertebrobasilar insufficiency can occur due to atherosclerosis of the subclavian, vertebral or basilar artery, less often repeated cardiogenic embolism, increased blood coagulation, polycythemia or vasculitis. Treatment of vertebrobasilar insufficiency includes the correction of vascular risk factors, the use of antiplatelet agents (aspirin) and vasoactive drugs (cinnarizine, tanakan, trental, etc.). More persistent dizziness, often accompanied by hearing loss, occurs when the internal auditory artery is blocked.