Many people complain of dizziness. But is the term still used wisely?
No. It is very often rather a feeling of instability, of “spinning head” with the impression that they are going to fall that describe the patients who present themselves to their doctor or to the emergency room. Sometimes it can be a simple vagaL discomfort.
How to define true vertigo?
Vertigo is associated with a sensation of movement. It’s like you’re on a merry-go-round, the room spins around you or you feel like you’re moving around the room.
An unpleasant feeling…
Even very scary. Hence this request for rapid support. But you should know that in the majority of cases, there is no medical emergency. Only a small proportion of dizziness can be serious. It is therefore important to eliminate a neurological emergency quickly.
What signs should alert?
We are particularly vigilant in the face of patients over 60 at risk of vascular disease: hypertensive, diabetic, etc. or who present certain associated symptoms: headaches, unusual neck pain Or who show associated neurological signs such as double vision, language, a motor deficit…
What are the neurological pathologies that can be announced by vertigo?
Among the serious pathologies likely to be revealed by dizziness, first and foremost are cerebral vascular pathologies (CVA and Transient Ischemic Attack – TIA), corresponding to an alteration of certain cerebral functions (transient for TIA, permanent for stroke), due to a lack of blood supply to the brain.
These situations are always an emergency. They expose them to a life-threatening risk or the persistence of a permanent disability, and must benefit from an assessment and treatment as soon as possible (every minute counts!). However, ignorance of stroke symptoms often leads patients to trivialize these episodes, and to wait for it to “go away by itself”.
Multiple sclerosis is also one of the neurological causes of vertigo. It requires specialized and rapid care.
What examinations to eliminate these causes?
Brain imaging (MRI) can eliminate these diagnoses, but rapid access to these examinations is often difficult.
Do ENT causes also justify rapid treatment?
ENT pathologies at the origin of vertigo do not usually constitute serious emergencies (apart from infectious circumstances, postoperative circumstances of the ear or lesions of the balance nerve). Their management in a short time is nevertheless desirable, for the well-being of the patient.
What are the main ENT pathologies involved in vertigo?
Among the best known is paroxysmal positional vertigo. This vertigo can be very marked, but remains benign. It is due to the displacement of microscopic structures in the inner ear, commonly called “crystals”; patients often report tossing and turning in bed at night and feeling dizzy. Their evolution is most often favorable, helped by liberating maneuvers sometimes vestibular rehabilitation.
Vestibular neuritis, another well-identified cause, is linked to inflammation of the nerve that innervates the vestibular structures (the inner ear). It causes a sudden and severe attack of vertigo, often rotary. The patient can no longer walk. The disorders can persist for several days, but they are generally treated very well. A specific rehabilitation is most often implemented.
Finally, some vertigo of ENT origin can occur in crises during life, in particular in connection with an increase in the pressure of the liquids of the inner ear. Deafness is usually associated with it. Ménière’s disease is the best known.
