Dizziness of peripheral etiology

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Dizziness[edit | edit source]

Dizziness is a subjective feeling of imbalance. It is accompanied by:

  • an objective disorder of the interplay of position and movement – deviations and falls ,
  • vegetative symptoms (nausea, vomiting, heart rate changes),
  • possibly anxiety.

Division[edit | edit source]

  1. vestibular
    • peripheral – damage to the labyrinth or n. VIII,
    • central – damage to the nuclei, pathways or cerebellum.
  2. extravestibular – with eye disorders and proprioception
Searchtool right.svg For more information see Vestibular syndrome.

The most common etiology of vestibular vertigo[edit | edit source]

  • overloading of the apparatus due to movement or an inappropriate gravitational field (weightlessness),
  • inflammations, tumors, injuries, toxins, drugs...

Symptoms[edit | edit source]

Peripheral disorder – harmony of individual symptoms (nystagmus, falls, deviations…).

Central disorders – characterized by disharmony - there is no connection between nystagmus and falls hearing impairment is absent, often there are other neurological symptoms.

Characteristics of dizziness[edit | edit source]

  • nature (turning, swaying, feeling of falling, weakness),
  • prodromes of dizziness (pressure in the ear, headache, tinnitus),
  • provoking factors (smoking, alcohol, drugs, position, movement, noise, optical sensations…),
  • accompanying manifestations (hearing loss, tinnitus, vegetative symptoms, neuro symptoms),
  • duration and intensity – vertigo primarily means spinning dizziness,
  • symptoms – malaise, vomiting, sweating, palpitations, nystagmus and ataxia (gait disorder).

Peripheral vestibular syndrome[edit | edit source]

Optokinetic nystagmus

It is caused by impairment of the balance system and/or nerve. In general, the more peripheral the lesion, the more accurate the patient's sense of the condition.

Unilateral disability[edit | edit source]

There is rotational vertigo with nausea, usually hearing is also affected. Difficulty worsens with head movements.

Bilateral disability[edit | edit source]

The patient complains of gait disturbances and unsteadiness (so-called ataxia). Difficulties worsen in the dark and on an uneven surface, there is often blurred vision during rapid head movements (so-called oscillopsia). Paradoxically, a bilateral chronically progressing lesion does not have many symptoms.

Nystagmus[edit | edit source]

Spontaneous nystagmus is almost always present – ​​horizontal or horizontal-rotational, unidirectional, often II-III degrees.

  • the intensity of nystagmus increases when looking in the direction of the fast component (Alexander's law ),
  • there is a positive correlation between the intensity of vertigo and nystagmus.

In this syndrome, vertigo without nystagmus and nystagmus without vertigo do not occur - eye fixation inhibits peripheral nystagmus (to prove it, we must avoid fixation - we use, for example, Frenzel glasses - thick glasses (+15D)...).

Nystagmus shows signs of fatigue – when the patient tries to stay longer with the eyes in one position, it disappears over time.

  • to the side of the diseased labyrinth it is irritating, to the opposite side it is destructive.

Symptoms[edit | edit source]

The syndrome is harmonious – all deviations have the same direction (eyes, movements...), only the fast component of the nystagmus goes in the opposite direction.

  • The intensity of the symptoms is determined by the size of the difference between the two apparatuses - tonic deviations are always directed to the side of the weaker apparatus (the stronger one pushes it...), i.e. to the side of the lesion - the slow component of the nystagmus goes to the side of the lesion, the fast component (given by the cerebral cortex's desire for correction) is in the opposite direction.
  • The direction of standing deviation depends on the position of the head, it usually deviates behind the affected ear – if the right ear is affected and we turn our head to the right, we fall backwards.

Benign paroxysmal vertigo[edit | edit source]

This is one of the most common causes of peripheral vertigo. A typical example is paroxysmal vestibular dysfunction.

  • the basis is the pathology of the posterior semicircular canal caused by the degeneration of the utricular macula - damage occurs after trauma, after surgery in the middle ear, after infection, aging.

Etiology[edit | edit source]

Small particles of cells containing minerals (otoconia) are released from the macula and travel into the canal - when moving the head, they affect the flow of endolymph, causing irritation.

Clinical picture[edit | edit source]

typical - with a certain position of the head, severe rotational vertigo occurs:

  • the patient's position is always the same - dizziness usually disappears within a few seconds,
  • other parts of the ear are not damaged (no tinnitus or hearing loss...).

Therapy[edit | edit source]

  • maneuver according to Semont – the goal is to remove otoconia from the canal.

Vestibular neuronitis[edit | edit source]

  • a common cause of vertigo - there is a sudden, complete, unilateral loss of vestibular function
  • etiology – probably viruses
  • symptom – sudden onset, severe rotational vertigo, nausea and vomiting, hearing loss and tinnitus are not
  • within a few days the situation will be corrected
  • treatment – corticoids

Meniere's disease[edit | edit source]

Searchtool right.svg For more information see Ménières's disease.

Links[edit | edit source]

Source[edit | edit source]

References[edit | edit source]

  • KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. edition. Galén, 2005. 224 pp. ISBN 80-7262-346-X.