dizziness

Dizziness

Impairment in spatial perception and stability.

Because the term dizziness is imprecise, it can refer to vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness.

One can induce dizziness by engaging in disorientating activities such as spinning.


Dizziness and vertigo are symptoms that commonly lead patients to seek neurologically or emergency care. Because symptoms are often vague and imprecise, a systematic approach is essential. By categorizing vestibular disorders based on the timing, triggers, and duration of symptoms, as well as emphasizing focused ocular motor and vestibular examinations, the majority of vestibular diagnoses can be made at the bedside 1).


Disequilibrium is the sensation of being off balance, and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting.

Presyncope is lightheadedness, muscular weakness and feeling faint as opposed to a syncope, which is actually fainting.

Non-specific dizziness is often psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation.

Dizziness etiology.


Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Bulbous corpuscles into diseased cervical discs may be related to cervicogenic dizziness.

Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain.

There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group.

This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis 2).


Dizziness, whether vague or specifically rotational, is a common sequel to head injury, and is often postural. One hundred and sixty-five patients with this symptom were examined. The simple posture tests employed to detect positional nystagmus are described. This physical finding was present in one-quarter of the entire group, and in nearly one-half of cases of longitudinal fracture of temporal bone. In such cases, it is an objective finding that corresponds precisely to the patient's complaint of vertigo.Transverse fracture of temporal bone destroys the inner ear in both cochlear and vestibular parts. Longitudinal fracture is commoner and causes bleeding from the ear; inner-ear damage is usually minor.In the rare cases where persisting postural vertigo and positional nystagmus are disabling, relief of the symptom may be achieved by vestibular denervation of the affected side 3).

Functional injury to centrally-mediated pathways, specifically oculomotor control, and afferent and efferent pathways in the cervical spine are commonly identified through clinical examination tests in individuals with a complaint of dizziness post-concussion. According to results presented here, a high majority (90%) of the participants demonstrated dizziness that appeared to be multifactorial in nature and was not attributable to one main type of dysfunction. The common pathways between the systems make it difficult to isolate only one anatomical area as a contributor to dizziness 4).


1)
Choi WY, Gold DR. Vestibular Disorders: Pearls and Pitfalls. Semin Neurol. 2019 Dec;39(6):761-774. doi: 10.1055/s-0039-1698752. Epub 2019 Dec 17. PubMed PMID: 31847047.
2)
Peng B, Yang L, Yang C, Pang X, Chen X, Wu Y. The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study. Bone Joint J. 2018 Jan;100-B(1):81-87. doi: 10.1302/0301-620X.100B1.BJJ-2017-0650.R2. PubMed PMID: 29305455.
3)
BARBER HO. DIZZINESS AND HEAD INJURY. Can Med Assoc J. 1965 May 1;92:974-8. PubMed PMID: 14285289; PubMed Central PMCID: PMC1928031.
4)
Reneker JC, Cheruvu VK, Yang J, James MA, Cook CE. Physical examination of dizziness in athletes after a concussion: A descriptive study. Musculoskelet Sci Pract. 2017 Nov 26;34:8-13. doi: 10.1016/j.msksp.2017.11.012. [Epub ahead of print] PubMed PMID: 29197811.
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  • Last modified: 2019/12/18 15:53
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