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Vertigo refers to a movement illusion or hallucination caused by the body's obstacles to spatial positioning.
According to statistics, the main complaint of vertigo accounts for about 5% to 10% in neurology clinics, about 6.
7% in hospitalized cases, and about 7% in otolaryngology clinics.
Vertigo is mostly caused by vestibular system diseases.
Patients have obvious foreign objects or sense of movement, such as rotation, shaking, deflection, etc.
, often accompanied by nausea, vomiting, and often sudden onset with obvious fear, and they go to the emergency department .
Examination and diagnosis process of emergency vertigo The examination and diagnosis process of emergency vertigo is shown in Figure 1.
Emergency treatment of vertigo General emergency treatment principles In the emergency treatment process, give emergency antiemetic treatment first, and try to find the cause at the same time.
The first exception is internal medicine and central diseases, followed by ear diseases.
Because patients with vertigo sometimes fail to pay attention to hearing, hearing loss can lead to hearing disability if hearing treatment is not timely, so sudden deafness must be excluded from the first episode of AVS.
For those with long-term and severe dizziness, especially those with more severe autonomic reactions such as nausea, vomiting and sweating, vestibular inhibitors can be used for short-term control (intensity of recommendation: B; level of evidence: Ⅱ) to control the symptoms of vertigo (in principle, use no more than 72 h), antiemetic treatment can be used if necessary (Recommendation strength: A; Evidence level: II).
Commonly used drugs are promethazine hydrochloride, difenidol hydrochloride tablets, diphenhydramine hydrochloride and so on.
See Table 2.
For acute-onset vertigo, drugs that improve circulation can be used as appropriate, such as gastrodin (Tianxuanqing), ginkgo biloba preparations, betahistine, etc.
(Recommendation strength: B; Evidence level: IV).Central vertigo (1) Acute cerebrovascular disease: For hyperacute cerebral infarction, those who meet the indications will be given emergency intravenous thrombolysis (alteplase, urokinase), intravascular interventional therapy and other rescue measures, and the loss of vascular recanalization Those who have the opportunity can be treated according to TOAST classification, such as anti-platen or anti-coagulation, lipid-lowering, control of risk factors, and plaque stabilization (statin drugs).
For patients with cerebral hemorrhage, the main treatment measures are dehydration to lower intracranial pressure, control blood pressure, and prevent complications.
For those with a certain space-occupying effect, dehydration treatment such as mannitol or glycerol fructose is required, and if necessary, surgery such as decompression and decompression of bone flap is required.
Surgical treatment.
(2) Vestibular migraine: mainly give symptomatic treatments such as analgesia and antiemetics.
(3) Central nervous system demyelinating diseases: Glucocorticoids or immunoglobulins and other immunomodulatory treatments are given.
(4) Central nervous system infection: Before obtaining the exact etiological evidence, antiviral (acyclovir, ganciclovir, etc.
) and antibacterial (ceftriaxone sodium, cefotaxime) can be given empirically according to its clinical characteristics Etc.
) and symptomatic and supportive treatments such as dehydration and lowering of intracranial pressure.
(5) Space-occupying lesions of the fourth ventricle and cerebellum: These space-occupying lesions will not be acute or paroxysmal in the early stage.
When the tumor is large to a certain extent, it will manifest as acute dizziness (dizziness), which needs attention.
See Table 3.
Psychosocial vertigo can be seen in panic attacks or generalized anxiety disorder, alprazolam, lorazepam, etc.
can be given.
See Table 4.
Yimaitong is compiled from: Guidelines for the Emergency Diagnosis and Treatment of Vertigo (2021).
Chinese Journal of Emergency Medicine, 2021.
According to statistics, the main complaint of vertigo accounts for about 5% to 10% in neurology clinics, about 6.
7% in hospitalized cases, and about 7% in otolaryngology clinics.
Vertigo is mostly caused by vestibular system diseases.
Patients have obvious foreign objects or sense of movement, such as rotation, shaking, deflection, etc.
, often accompanied by nausea, vomiting, and often sudden onset with obvious fear, and they go to the emergency department .
Examination and diagnosis process of emergency vertigo The examination and diagnosis process of emergency vertigo is shown in Figure 1.
Emergency treatment of vertigo General emergency treatment principles In the emergency treatment process, give emergency antiemetic treatment first, and try to find the cause at the same time.
The first exception is internal medicine and central diseases, followed by ear diseases.
Because patients with vertigo sometimes fail to pay attention to hearing, hearing loss can lead to hearing disability if hearing treatment is not timely, so sudden deafness must be excluded from the first episode of AVS.
For those with long-term and severe dizziness, especially those with more severe autonomic reactions such as nausea, vomiting and sweating, vestibular inhibitors can be used for short-term control (intensity of recommendation: B; level of evidence: Ⅱ) to control the symptoms of vertigo (in principle, use no more than 72 h), antiemetic treatment can be used if necessary (Recommendation strength: A; Evidence level: II).
Commonly used drugs are promethazine hydrochloride, difenidol hydrochloride tablets, diphenhydramine hydrochloride and so on.
See Table 2.
For acute-onset vertigo, drugs that improve circulation can be used as appropriate, such as gastrodin (Tianxuanqing), ginkgo biloba preparations, betahistine, etc.
(Recommendation strength: B; Evidence level: IV).Central vertigo (1) Acute cerebrovascular disease: For hyperacute cerebral infarction, those who meet the indications will be given emergency intravenous thrombolysis (alteplase, urokinase), intravascular interventional therapy and other rescue measures, and the loss of vascular recanalization Those who have the opportunity can be treated according to TOAST classification, such as anti-platen or anti-coagulation, lipid-lowering, control of risk factors, and plaque stabilization (statin drugs).
For patients with cerebral hemorrhage, the main treatment measures are dehydration to lower intracranial pressure, control blood pressure, and prevent complications.
For those with a certain space-occupying effect, dehydration treatment such as mannitol or glycerol fructose is required, and if necessary, surgery such as decompression and decompression of bone flap is required.
Surgical treatment.
(2) Vestibular migraine: mainly give symptomatic treatments such as analgesia and antiemetics.
(3) Central nervous system demyelinating diseases: Glucocorticoids or immunoglobulins and other immunomodulatory treatments are given.
(4) Central nervous system infection: Before obtaining the exact etiological evidence, antiviral (acyclovir, ganciclovir, etc.
) and antibacterial (ceftriaxone sodium, cefotaxime) can be given empirically according to its clinical characteristics Etc.
) and symptomatic and supportive treatments such as dehydration and lowering of intracranial pressure.
(5) Space-occupying lesions of the fourth ventricle and cerebellum: These space-occupying lesions will not be acute or paroxysmal in the early stage.
When the tumor is large to a certain extent, it will manifest as acute dizziness (dizziness), which needs attention.
See Table 3.
Psychosocial vertigo can be seen in panic attacks or generalized anxiety disorder, alprazolam, lorazepam, etc.
can be given.
See Table 4.
Yimaitong is compiled from: Guidelines for the Emergency Diagnosis and Treatment of Vertigo (2021).
Chinese Journal of Emergency Medicine, 2021.
