The diagnosis and treatment of recurrent dizziness and vertigo is done in one article!

*Only for medical professionals to read for reference.
Repeated troubles, how to solve it completely? Dizziness and vertigo are common brain dysfunctions, which are common clinically, and the disease repeatedly causes many troubles to patients
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From July 9th to July 11th, at the 7th Academic Annual Meeting of the Chinese Stroke Society (CSA&TISC 2021), Professor Qi Xiaokun from the Sixth Medical Center of the Department of Neurology, General Hospital of the People’s Liberation Army gave "Diagnosis and Treatment of Recurrent Dizziness and Vertigo" Have a wonderful lecture on this topic, learn together! 1 The concept of recurrent dizziness and vertigo.
Dizziness: refers to the feeling of impaired or impaired spatial orientation, without the false or distorted feeling of movement, that is, the feeling of no or non-rotational
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Vertigo (vertigo): refers to the self-motor sensation when there is no self-movement or the self-motor sensation that is distorted during normal head movement
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Including false rotational sensations (rotational vertigo) and other false sensations such as rocking, falling, floating, bouncing or sliding (non-rotational vertigo)
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Recurrence: Refers to the same symptom occurring twice or more
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Recurrent dizziness and vertigo: Refers to recurrent dizziness and/or vertigo symptoms
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2 Diagnosis of recurrent dizziness and vertigo Professor Qi Xiaokun introduced that the diagnosis and differential diagnosis of recurrent dizziness and vertigo should consider factors such as the onset of disease, frequency of attacks, duration of symptoms, etc.
The etiology is mainly based on the MIDNIGHTS principle, one by one investigation
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Figure 1: The common causes of the MIDNIGHTS principle Figure 2: The structure of recurrent dizziness and vertigo involved structure etiology classification structure Figure 1.
Vestibular migraine: acute onset, the most frequent recurrence (can be several weeks, months, or years of recurrence, the most Ten times or more), symptoms last from a few minutes to about 3 days, mainly dizziness, with or without headache
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2.
Benign paroxysmal positional vertigo (otolith): Acute attack, the total frequency of recurrence is several or more, and the duration of each vertigo is calculated in seconds, which is related to changes in head position, and ranks among the number of dizziness/vertigo diseases.
In the first place
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3.
Cerebral infarction or posterior circulation ischemia: acute or subacute attack, which may be accompanied by motor, sensory or language disorders, and the average number of recurrences is about several times
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4.
Brainstem demyelinating disease, brainstem encephalitis: acute or subacute attack, which may be accompanied by motor, sensory or language disorders, and recurrence is relatively rare
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5.
Vestibular neuritis: Acute attacks, mainly single attacks, severe dizziness, lasting several days to several weeks, vestibular neuropathy sideways when standing, and a small proportion of the total number of dizziness/vertigo
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6.
Meniere's disease: acute attack, recurrence (but less frequently), severe dizziness, low-key tinnitus, progressive hearing loss, dizziness, and ear fullness that last several days to several weeks
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7.
In chronic persistent dizziness/vertigo, subjective dizziness/vertigo/persistent postural-perceptual dizziness (PPPD), hypertension, and orthostatic hypotension are more common
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Such patients account for a larger proportion
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Figure 3: Flow chart of diagnosis of recurrent dizziness and vertigo 3 Diagnosis of recurrent dizziness and dizziness 1.
The etiology of recurrent dizziness, clinically, vestibular migraine, benign paroxysmal positional vertigo, and psychogenic dizziness are the most common
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2.
The medical history of patients with recurrent dizziness and vertigo began to be asked when they were young; to ask whether they had any previous headaches, and whether there was a family history in people over three generations.
Family history is suggestive for certain diseases
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3.
Middle-aged and elderly people should consider whether it is the cause of atherosclerosis, first consider common causes
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4.
"Dizziness/dizziness every day" should consider the identification of psychogenic dizziness, which requires evaluation of mental state and personality, and even more psychosocial treatment
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5.
Repeated dizziness: "dramatic" attack, attack period: turbulent waves, rivers and seas, vomiting and diarrhea, profuse sweating
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After the attack: the rain has passed the sky, the wind is calm and the waves are still intact
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Imaging examination: Part of MRI showed "lacunar-like" small lesions in the subcortex and semi-oval center.
Attention should be paid to the identification, diagnosis and treatment of "vestibular migraine"
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6.
Pay attention to the diagnosis of recurrent dizziness and vertigo, which can be converted or combined with other diagnoses along with the course of the disease.
Don't "see the trees but not the forest"
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4 Treatment of recurrent dizziness and dizziness ■ The principle of treatment during the attack period is to treat the vestibular symptoms such as dizziness, dizziness, and vomiting, with a vestibular inhibitor or a sedative
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■ Interictal treatment is based on comprehensive consideration of the onset frequency, duration, severity, and impact on quality of life of patients with dizziness/dizziness and other clinical symptoms
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Preventive drug treatment is given .

■ Traditional Chinese medicine treatment follows the principle of treating the symptoms while treating the root cause
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According to the frequency of seizures and disability, circulatory improvement drugs were given sequentially or individually during the attack period and the interictal period
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