In 2009, the Classification Committee of the Bárány Association (CCBS) classified vestibular disease symptoms into 4 categories: vertigo, dizziness, vestibular visual symptoms and postural symptoms.
International Classification of Vestibular Symptoms
Vertigo (vertigo): refers to the feeling of self-movement of the head or trunk in the absence of self-movement, or a distorted sense of self-movement during normal head movement, typically The feeling of dizziness may also appear as shaking, tilting, rising and falling, jumping or sliding. Including spontaneous vertigo and induced vertigo.
Dizziness (dizziness): Refers to the feeling of disorientation or impairment of spatial orientation of the head without a false or distorted sense of movement. But there are no motion illusions, hallucinations or distorted sensations. Including spontaneous dizziness and induced dizziness.
Diagnosis of dizziness/vertigo
The cause of dizziness/vertigo is complex, and the diagnosis involves multiple disciplines. However, as a common clinical symptom, its diagnostic ideas still follow the basic principles of disease diagnosis - detailed medical history inquiry, physical examination After that, auxiliary examinations are selected to support the diagnosis in a targeted manner, and the etiological diagnosis is obtained through comprehensive analysis.
Diagnosis process of dizziness/vertigo in emergency room
In the clinical diagnosis of dizziness/vertigo, malignant central vertigo disease caused by brainstem and cerebellar lesions needs to be excluded first. Therefore, the following signs suggesting central lesions need to be paid attention to: disturbance of consciousness, diplopia, abnormal eye movement, visual field defect or blur, speech disorder, dysphagia, choking on drinking water, central facial and tongue paralysis, crossed or hemibody sensory disorder , hemilateral or limb weakness , ataxia or severe balance disorder. Referral to neurology when positive neurological signs occur. Be sure to check the hearing of patients with dizziness/vertigo. If acute hearing loss is found, please consult an otolaryngologist. In addition to the typical signs suggesting central lesions, special neuro-otological examinations should also be paid attention to, especially the examination of eyeball position, eye movement and nystagmus .
In diagnosing dizziness/vertigo, medical history inquiry is particularly important. 's detailed and comprehensive medical history collection can provide important direction and basis for the diagnosis and differential diagnosis of dizziness/vertigo. 70% to 80% of vertigo patients can obtain a preliminary diagnosis through detailed medical history questioning. recommends that the diagnosis should be based on the onset form and duration, which will be helpful in quickly narrowing the scope of diagnosis and differential diagnosis.
. Prioritize clarification through consultation: ① The attack form of dizziness/vertigo: such as acute and persistent, recurrent or chronic; ② Duration of dizziness: seconds, minutes, hours or days. Through these two questions, the patient's clinical manifestations are first included in the diagnosis of acute persistent dizziness/vertigo, recurrent dizziness/vertigo, or chronic persistent dizziness/vertigo.
. Further identify the disease based on the nature of the halo, the way it is induced and aggravated, and the accompanying symptoms, especially abnormal body movements or sensation , abnormal speech expression, unsteady standing or gait, blurred or double vision, hearing loss, etc., to further identify the disease. The site may be located in the peripheral vestibular organs (such as the semicircular canals or otolith organs), the central vestibular system (such as the brainstem, cerebellum), or the non-vestibular system.
. There are some diagnostic pitfalls that require high vigilance: vertigo without positive findings in routine neurological physical examination (such as hemiplegia, speech impairment, etc.) is not necessarily peripheral vertigo, and vertigo accompanied by hearing damage is not necessarily peripheral. dizziness.
The common causes of dizziness/vertigo classified based on different attack forms and lesion locations are shown in the table below (Table 1). A comprehensive analysis combined with the onset form and lesion location can provide certain hints for the diagnosis of the cause.
Table 1 Common causes of dizziness/vertigo based on different attack forms and lesion locations
Note: Recurrent symptoms caused by non-vestibular system diseases are mostly dizziness, rarely rotational vertigo
dizziness/vertigo Differential diagnosis
. The clinical characteristics, identification and precautions of common acute persistent dizziness/vertigo, episodic dizziness/vertigo and chronic persistent dizziness/vertigo are shown in the table below (Table 2, Table 3, Table 4).
Table 2 Common clinical characteristics of acute persistent dizziness/vertigo diseases
Table 3 Clinical characteristics of common episodic dizziness/vertigo diseases
Table 4 Clinical characteristics of common chronic persistent dizziness/vertigo diseases
. Other causes of dizziness/vertigo Conditions include: cervicogenic dizziness, drug-induced dizziness/vertigo, and dizziness/vertigo disorders of unknown etiology.
Reference:
. Guidelines for primary care diagnosis and treatment of dizziness/vertigo (2019) [J]. Chinese Journal of General Practitioners, 2020, 19(3):201-209.
. Guidelines for emergency diagnosis and treatment of vertigo (2021) [ J]. Chinese Journal of Emergency Medicine, 2021, 30(4): 402-406.
. Ju Yi, Zhao Xingquan. Update the concept of dizziness/vertigo and clarify diagnosis and treatment ideas [J]. Chinese Journal of General Practitioners, 2020, 19(3) ):198-200.
