Diagnosis of dizziness or vertigo

The most appropriate specialist to treat dizziness is an ENT specialist or neurologist who can make the diagnosis based on:

  • No historical doctor,
  • At physical examination,
  • In the vestibular and auditory tests,
  • In magnetic resonance imaging of the brain ,
  • On color Doppler ultrasonography of the carotid arteries (in the neck ).

It is necessary to exclude cardiovascular diseases (which are predominant in the diabetic patient ).

Physical tests to evaluate the functionality of the lobby

Romberg’s Test
Standing, feet together, arms at the side of the body and eyes closed.

The positive Romberg test can mean:

  1. Vestibular damage : with a slight delay, the patient leans over and then falls to the side of the vestibule that does not function properly.
  2. Sensory ataxia : with eyes closed the patient swings in all directions and may fall forward, backward or sideways.
  3. The patient can not stand with the small footrest; it is said that the individual can not maintain the position of Romberg and the cause is a problem in the cerebellum.

If the patient is stable, it is necessary to take the Unterberger test.

 

Indicator test
Patient position: sitting with eyes closed, arms extended forward and fingers pointing to the doctor in front. 
If there is a problem in the maze, the indicators move in the horizontal or vertical direction.

Tests by Unterberger

Unterberger Testing
Feet together and arms stretched forward with eyes closed. 
The test consists of walking, raising the knees approximately 45 °, but without moving. 
Healthy people remain in the same position, while those who have a disorder advance more than 1 meter or make a rotation of at least 30 ° to the diseased side.

Dix-Hallpike
Test In this test, a person moves from sitting to lying on the stomach, with the head turned 45 degrees to one side (for example, to the left) and extended about 20 degrees behind. 
In this position you can observe the eyes of the patient: the test is positive if the patient has nystagmus (vibration of the eye) and dizziness. 
Otherwise, the test is repeated to the right side.

Useful is the study of nystagmus that can be observed:

  • With the naked eye,
  • With Frenzel glasses, that is, a mask with lenses that cause myopia to +20 diopters. 
    In this way, the patient can not fix; otherwise, the risk is not to notice peripheral nystagmus. 
    The patient sees only a few blurred outlines.

A more modern method for investigating nystagmus is a mask with two infrared cameras that reproduce the enlarged image of the eyes in a video.

For the differential diagnosis between central and peripheral nystagmus , it is necessary to understand the direction.

If the patient is sitting or standing and looking forward, the neurologist should be consulted if the nystagmus hits:

  • Up,
  • Down.

Generally, the nystagmus that originates in the labyrinth strikes to the opposite side to the compromised ear, depending on the channel involved. If the pathology affects the semicircular canal:

  • Posterior or lateral, the nystagmus is horizontal or horizontal and rotational,
  • Anterior, nystagmus is vertical (very rare occurrence).

Only in Ménière’s disease does  nystagmus hit the affected side, but this is an exception. 
In the erect position, positional nystagmus can not be seen and therefore it is necessary to make specific maneuvers to identify it. 
With some movements, the otoliths go to the eyelashes of the semicircular canals and cause nystagmus.

Vertigo is rarely present as the only symptom; therefore, for the diagnosis the other health problems should also be evaluated.

It is necessary to evaluate:

  • The function of cranial nerves,
  • Possible movement problems,
  • Disdiadococinesia,
  • Other neurological symptoms.

Depending on the disorder, healing times are very different. 
A peripheral labyrinth problem improves at variable times, but often the body is able to compensate for the poor functioning of the vestibular apparatus, so that the improvement is fast enough (except in the case  of Ménière’s syndrome ).

There are nerve endings that:

  • They can replace the maze,
  • They allow the body to maintain balance.

In the case of damage to a nerve with reduced signals to the vestibular nucleus in the brain, the cerebellum can inhibit signals from that nerve to keep the system in balance.

In the absence of labyrinthine signs, the cervico-oculomotor reflex can replace the function of the affected labyrinth. 
However, in some cases, for example in the case of musculoskeletal disorders of the neck , it may not work properly.

Another system that can interfere in the cervical reflex is in the masticatory system:

  • Ear-jaw articulation,
  • Dental arch,
  • Dental alveoli,
  • Gums.

Here are many nerve receptors that can provide a lot of proprioceptive information (about the position of the body in space) to the brain. 
Many people with a labyrinth disorder can not regain balance due to a masticatory system that does not function properly, as in the case of bruxism .

There is an important correlation because the signal that originates in the masticatory system travels through the ascending root of the trigeminal nerve and reaches the vestibular nucleus of Deiters (from where the vestibular-spinal beam forms part).

There may be interference between the vestibular system and the mind . 
In many scientific studies, it is hypothesized that the affected labyrinth will not be replaced by other nerve endings or reflexes because the nervous system is in a state of hyperexcitation. 
The cause is the indirect connection between the amygdala (part of the brain that manages the emotions) and the vestibular nuclei:

  • Medial,
  • Lateral.

This connection passes through the brainstem and the parabrachial nucleus. 
Therefore, in anxious patients , compensation can be hampered.

 

Diagram of the diagnosis

The first thing to do is to identify the area of ​​the injury. 
Then, it is necessary to understand if there are extravestibular factors that can influence the compensation. 
Finally, a general patient assessment is needed in collaboration with other specialists:

  1. Dentist,
  2. Orthopaedist,
  3. Physiatrist,
  4. Psychiatrist.

Medications for dizziness

In case of very strong dizziness, there are medications that can reduce the symptom quickly:

  • The antihistamines such as promethazine (Phenergan), whether it is caused by Meniere’s syndrome.
  • Alternatively, the physician may administer 500 cc of saline with the addition of levosulpiride .

In the post-acute phase, when the symptoms are less intense but have not completely passed, the doctor may prescribe cholinergic medications to favor the compensatory mechanisms of the vestibular system.

Histaminergic drugs, such as betahistine (Labirin), are indicated only for Ménière’s syndrome .

Medications with antiemetic effect

DrugIndication
CyclizineMotion sickness or motion sickness, has a good effect and causes less drowsiness  than generic antihistamines.
CinarizinaMovement disorder, vestibular disorders (eg Ménière’s disease)
Prometazine (Fenergan)Severe morning sickness in pregnancy . Today it is less prescribed because it causes a lot of drowsiness.

 

Diet and feeding for dizziness

Vertigo can also be caused by poor diet. 
According to the blood type diet theory , dizziness can be caused by foods that are not compatible with the immune system . 
Depending on a person’s blood type, some foods can be tolerated, while others can cause symptoms and illness. 
However, everyone can get dizzy if they eat:

  • Cereals with gluten ,
  • Milk and dairy products.

Natural diets can reduce symptoms because:

According to hygienism , body health depends on diet and lifestyle. 
An incorrect diet causes the accumulation of toxins in the blood and the consequence is the development of symptoms and diseases. 
Natural medicine considers the person as a whole, so that a disorder in an organ can not be considered in isolation. 
The diet recommended by hygienists is vegan with most raw foods and it is necessary to avoid:

  1. Milk and dairy products,
  2. Meat,
  3. Fish,
  4. Eggs,
  5. Sweets and processed products,
  6. Sugary, gassy or stimulant drinks.

Natural Remedies for Dizziness

For benign paroxysmal positional vertigo there are several effective liberatory maneuvers . In other cases, the remedies listed below may reduce the symptoms.

 

Indian gooseberry (Amla)

Indian gooseberry is a popular ayurvedic remedy for dizziness. 
This remedy is a source rich in vitamins A and C which:

  • They strengthen the immune system,
  • Improve blood circulation,
  • They help treat and prevent dizziness.

Preparation method:

  1. Moa 2 fruits of Indian gooseberry (seedless),
  2. Mix with 2 teaspoons coriander seeds and a glass of water,
  3. Let rest for one night,
  4. The next morning, filter and drink the water,
  5. Repeat daily for a few days.

 

Deep breath

Deep breathing is one of the best ways to combat dizziness. 
According to  top10homeremedies.com , it allows to bring enough oxygen to the brain and therefore:

  • It relaxes the nervous system,
  • Reduces vertigo.

How to do deep breathing?

  1. Sit or lie down in a comfortable position.
  2. Put a hand on the abdomen.
  3. Place the thumb of your other hand against a nostril and close your mouth.
  4. Inhale slowly through the open nostril until the lungs are filled with air.
  5. Hold your breath, close both nostrils and squeeze your lips.
  6. After 2 or 3 seconds, exhale slowly and try to draw air from the stomach.
  7. Repeat these steps 10 times.
  8. Then sit quietly for 5 minutes and breathe normally to avoid dizziness again.

 

Ginkgo biloba

Ginkgo biloba is another effective home treatment for dizziness. 
Helps improve blood flow to the brain to stop or prevent dizziness . 
In addition, this herb helps treat tinnitus that can occur along with vertigo. 
This herb is available in the form of:

  • Tablets,
  • Liquid Extract,
  • Dry leaf.

The standard dosage is 120-150 mg of ginkgo biloba extract, in 3 doses per day for a few months. 
Note: Ginkgo biloba may interact with some medicines. 
Consult a physician before taking this supplement.

 

Ginger

Ginger is a medicine tested over time for dizziness and motion sickness . 
It stimulates blood flow to the brain and other parts of the body, thus helping to reduce the intensity of vertigo.

  1. Chew a small slice of fresh ginger root or suck a ginger bullet to make the dizziness go by.
  2. Drinking an infusion of ginger a few times a day helps prevent dizziness.

Tips to avoid dizziness

  • Sit or lie down immediately if you feel dizzy.
  • In case of loss of balance and dizziness, lie down and concentrate on the immobile objects around you. It distracts the mind from vertigo.
  • Insert a number of physical exercises into daily life to improve blood circulation throughout the body and avoid dizziness.
  • Avoid getting out of bed quickly.
  • Avoid drinking caffeine, alcohol and tobacco , as these substances can worsen illnesses that cause dizziness.

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