Unsteady gait, dizziness. Causes of dizziness in a horizontal position

Coordination of movements and retention own body in space - this is natural process. A person does not think about the mechanism of its action until a disruption occurs. Balance disorders can have different sources and symptoms. The most common occurrence is dizziness when walking. It is characterized by acute attacks that can lead to unsteady gait and falls. For what reasons does the world “move” around you?

Causes of vertigo that occurs when walking

Impaired balance when walking occurs due to inconsistency of signals between the vestibular and sensory systems entering the cerebral cortex. They are formed as a result of intoxication of various origins, ear diseases or changes in the vestibular system, lesions of the brain or spinal cord.

By type, such conditions can be divided into:

System."True" vertigo. You feel the movement of your own body or objects around it, literally everything around you moves, your gait becomes uncertain and shaky. Attacks of lightheadedness may occur.
Non-systemic manifestations- characterized by darkening of the eyes, muscle weakness, nausea, and a feeling of impending fainting.

Systemic signs indicate problems with the vestibular and/or hearing system, possible damage to the brain or spinal cord. Non-systemic, most often, are the result of chronic diseases of the cardiovascular, endocrine, respiratory system.

Dizziness of any kind can occur when walking, without serious reasons for it. Abrupt change body position, acceleration during movement, sudden stop - all this can become the basis for temporary short-term vertigo. Poisoning with any substances (paint fumes, exhaust gases, medications, etc.), a state of alcoholic or drug intoxication causes real dizziness.

Diseases that cause dizziness

Failure in coordination appears as a result of inconsistent actions of signals from the vestibular and sensory systems.

Violation cause various kinds poisoning, diseases of the hearing aid, damage to the brain and spinal cord and other diseases.

At this time, dizziness occurs when walking without objective reasons– in the process of accelerating walking, a sudden stop, a sudden change in body position, as well as during alcohol intoxication.

Causes and treatment of dizziness when walking

Coordination and maintaining balance in space is a natural process.

A person can think about how such a process functions only in a situation when he notices dizziness and various kinds failures.

Impaired coordination causes a variety of pathological processes or diseases. To choose effective treatment, it is necessary to establish the reasons that cause dizziness when walking.

Dizziness occurs due to the fact that signals from the vestibular apparatus and sensory system work inconsistently.

Causes

Vertigo is divided into systemic and non-systemic. The first are formed in the presence of difficulties with the vestibular or hearing system, damage to the brain or spinal cord.

The latter are associated with chronic diseases of cardio-vascular system and endocrine systems.

Causes of dizziness when walking:

Violation of the vestibular apparatus. The main provoking factor of failure in coordination. During the pathological process, balance is lost, the gait becomes unsteady when walking, and nausea is noted. Short-term or persistent damage to the vestibular apparatus is observed during vestibular neuronitis, labyrinthine neuroma or auditory nerve, Meniere's disease.
Damage to the central nervous system. Leads to musculoskeletal disorders cerebral paralysis, Parkinson's disease, polyneuropathy. These diseases provoke dizziness and unsteady gait, weakness in the limbs, and hard muscles.
Damage to the cerebellum. Such pathologies provoke an intense feeling of rotation, leading to a fall. Failures in coordination can only occur in a standing position and when walking.
VSD. Due to impaired vascular tone, dizziness occurs. The sensations intensify during a sharp rise and when walking. A shaky gait also provokes neuroses and depression.
Osteochondrosis in cervical spine. Squeezing vertebral artery with this disease, it provokes a loss of balance, the patient begins to stagger when walking, he becomes dizzy, there are discomfort in the head, the heartbeat quickens, the epithelium turns red or pale.
Vascular cephalalgia. A disorder of the blood supply to the brain provokes vertigo, which becomes stronger while walking, the condition is accompanied by unpleasant pulsating pain in the head, pain in the back of the head, “spots” before the eyes, and a feeling of spatial disorientation.

Types of dizziness

Experts distinguish dizziness, which worries the patient and prevents him from walking, into certain types. These include:

Systemic dizziness. Provokes an unsteady gait, weakness in the legs, and a feeling of rotation of the surrounding reality. In addition, nausea is observed. Brain damage or spinal cord disease.
Unsystematic dizziness. Expressed general malaise, gag reflex, fainting and blurred vision. Pathological processes such as heart and vascular diseases are considered to be a provoking factor for such symptoms. In addition, specialists are able to identify hormonal disorders or difficulties with the respiratory organs.
Temporary dizziness. Occurs during a sudden stop or acceleration of walking. These phenomena are not capable of causing any danger to life.
Psychogenic dizziness. Caused by sleep disturbances, constant stressful situations, malaise, apathy or anxiety.

Dizziness and unsteady gait observed in the process of body poisoning, alcohol intoxication, overdose drugs or medications.

Symptoms

Each type of vertigo has its own symptoms. However, there are also common symptoms that people complain about a large number of patients:

Nausea.
Feeling empty in the head.
Weakness in the legs. Dizziness is often associated with an unsteady gait.
Rotation of objects.
Blurred outlines before the eyes.
Loss of coordination and balance.
Increased sweating.
Difficulty with heartbeat.
Regular panic attacks.
Fainting states.

When weakness is in lower limbs and dizziness occurs infrequently, then you should not panic. But if an unsteady gait appears constantly when walking, you should immediately contact a specialist.

There are quite a lot of provoking factors for such phenomena, so an independent examination can not only not help, but also significantly harm.

First aid

When a patient suddenly becomes dizzy, he needs to carry out certain instructions. These include:

Find a foothold.
Do not panic.
Concentrate your gaze on one point.
Elderly people need to remove dentures, if any. The head feels dizzy in this situation due to compression of the dental nerve.
When vertigo appears indoors, it is possible to simply go outside Fresh air or ventilate the room.
If you have a tonometer, mandatory measure blood pressure.
If your general health worsens, you should immediately call a doctor.

Before the ambulance arrives, you are prohibited from taking any medications. Such actions can distort the clinical picture.

Treatment

At the moment, there are many options for eliminating unpleasant and dangerous symptoms: gag reflex, dizziness, unsteady gait.

Drug treatment, physiotherapy, and traditional medicine are used.

Drug therapy

When the causes of the pathology have been discovered, doctors will prescribe symptomatic treatment. The following drugs can be used:

Antihistamines that normalize the functioning of the vestibular apparatus and restore blood flow in the inner ear.
Dimenhydrite, which blocks the gag reflex. It is necessary to take into account that such a medication has certain disadvantages. For example, its use leads to apathy and fatigue.
Diazepam can relieve dizziness and reduce the sensitivity of the vestibular apparatus to the external environment.
Vitamin B and drugs to improve blood flow in the brain.
Ephedrine, leading to inhibition of the active activity of the vestibular system.
A tranquilizer that reduces the number of negative emotions and relieves nervous tension.

Physiotherapy

In order to improve blood circulation in the neck, it is necessary to reduce tension in the muscles and ensure a constant flow of oxygen to the brain. Experts recommend physical therapy.

Conventional treatment is based on the following procedures:

Phonophoresis.
Magnetotherapy.
Electrophoresis.
Acupuncture.
Therapeutic baths.
Massage.

When you feel dizzy, treatment should be carried out by a highly qualified doctor with the necessary skills. Besides, this treatment requires special equipment.

ethnoscience

When a patient refuses to use medications, then experts can recommend traditional therapy for him.

The following are the most common and effective means:

Ginger as powder or capsule.
An extract from mistletoe that increases blood flow in the process of atherosclerosis.
Ginkgo biloba and garlic improve blood flow.
Decoction of red clover, which cleanses blood vessels and eliminates dizziness.
A bow that eliminates unsteady gait.
Veronica infusion reduces the excitability of the central nervous system.

TO traditional therapy Often resorted to by patients who are prone to allergies to the use of medications.

Dizziness when walking is unpleasant symptoms. The causes and treatment of the pathological process are individual, so it is necessary to seek help from a specialist.

IN for preventive purposes you need to eliminate the consumption of coffee, sugar and salt; drink plenty of fluids; do not get up abruptly from the table after eating. Don't ignore the symptoms of illness.

It is easier to make a timely diagnosis and begin treatment than to start dizziness and expect the occurrence of dangerous pathological processes.

Useful video

Each of us has experienced dizziness at least once. It is caused by serious illnesses, and minor external irritants, can be either an alarming symptom or a harmless short-term sensation.

Sometimes this disease can manifest itself sharply, in an intensified form, with an attack of nausea.

In another situation, dizziness is observed throughout long period without causing any particular trouble to the person.

This article describes in detail why you feel dizzy, what types of this disease there are, what to do if you feel dizzy, and what can cause it.

Often this term means something completely different. Feeling darkening in the eyes, flickering, bright light, ringing in the ears,. Some may mistakenly say that they constantly feel dizzy.

Decreased hearing sensitivity in special situations, muscle weakness can be perceived as dizziness.

In fact, this term characterizes only the sensation of apparent rotation, general or “inside the head.” True dizziness is also called “vertigo”.

Why do you feel dizzy and stagger when walking?

This condition can occur from taking medications, various diseases(dental or ear diseases), due to an unstable emotional background or due to overwork.

However, there are two main types of this disease: peripheral vertigo and central.

Peripheral (not systemic). It comes with a sudden headache and lasts from a few moments to a couple of hours. At the same time, the person feels suddenly dizzy. He may also feel loss of balance, sweating, thirst, and nausea. Very often this is accompanied by pain in the ear on one side, as well as significant worsening with sudden movements of the head. There are no focal neurological symptoms.
Central (systemic). Most often associated with brain diseases. Characterized by an abrupt onset and long-lasting action. A person may feel dizzy from time to time. In this case, there is a lack of coordination of movements for weeks and even months; dizziness almost does not increase when turning the head. Focal neurological symptoms may appear.

When visiting a doctor, it is important to be able to correctly explain the nature of your sensations, which will help you quickly make a diagnosis and apply the appropriate treatment.

If you always feel dizzy, then talk about it, remember exactly when these signs of illness began to appear, and when dizziness is most noticeable (in the morning, evening or night).

It is important to understand that dizziness is not an independent disease, but only a syndrome, and depends on the nature of the disease that caused it.

Manifestation of pathology or reaction to an external stimulus: how to determine

In some cases, when the head hurts or feels dizzy, this may not be related to pathology, the body’s natural reaction to external stimuli, For example:

Water, land and air transport. Just like motion sickness, dizziness all the time while in a moving vehicle is absolutely normal for people with a sensitive vestibular system. According to statistics, this most often occurs in children under 12 years of age, whose vestibular apparatus has not yet fully developed.
Carousels. Riding on a carousel is often accompanied by dizziness, which is normal reaction brain for a quick change of picture and rotation of the body. After you've been on the carousel, your head may continue to spin throughout the day.
Stress. Typically, strong positive or negative emotions are accompanied by a surge of adrenaline, which can cause dizziness. A sharp surge of adrenaline in stressful situations is also the norm. There are many diseases that force a person to be in constant fear, panic, rage, and they should not be confused with ordinary stress. They provoke a surge of adrenaline and dizziness. Such diseases include, for example, pheochromocytoma.
Height. When a person rises to a significant height, his gaze is directed into the distance and does not have the ability to sharply switch to surrounding objects. Dizziness in such situations is normal, especially if the person has a fear of heights.
Exhaustion, severe fatigue. Usually accompanied not only by dizziness, but also by headache, which is concentrated in the temporal lobe. After healthy good sleep This dizziness goes away the next day.
Lack of food and drink. Dizziness can occur due to a sharp lack of food and water. If a person gradually limits himself, over weeks or even months, then the body calmly adapts. Even if you haven’t eaten for only 8 hours, but before that you constantly had a hearty breakfast and lunch, this can even cause loss of consciousness. Usually, this is not a pathology, but irregular nutrition can be accompanied by serious gastrointestinal diseases. In this case, the head does not become more dizzy with sudden movements. If you have been dizzy all day and haven’t eaten anything, then you just have to eliminate the cause and your condition will return to normal.
Sudden change of position. A common reaction when you suddenly get out of bed in the morning is a darkening of your vision, especially if you haven’t slept well before. In such a situation, you should drink a glass cold water and lie down a little, try to get up again, not so abruptly.

If you sometimes feel dizzy in the above situations and have no other complaints, then there should be no cause for concern, and medical assistance is not mandatory.

Dizziness due to medications

Often, some medications have such a strong effect on a person that he begins to feel discomfort in the Everyday life: headache, dizziness, darkening of the eyes, nausea.

In the instructions for many medications it is indicated that the reception of this medicine may cause dizziness.

In this case, if the patient strictly followed the instructions and did not use the drug in large doses, this is not a pathology and does not require separate treatment.

The following are some categories of drugs that may cause dizziness:

Antibiotics. Many drugs from this category can have a strong effect on the body, causing nausea, lack of appetite, headache and dizziness.
Allergy medications. Most often, taking this particular category of medications is accompanied by dizziness, since they have an extreme effect on the vestibular system.
Sedatives. They lower blood pressure and pulse, causing muscle weakness and dizziness. Sometimes a severe headache or a feeling of pressure in the ears may develop. This usually happens with overdose.

If you start to feel dizzy when taking any of the above medications, and the instructions indicate this by-effect, then it cannot be considered a pathology and does not require special treatment.

If this sensation bothers you greatly, contact your doctor and ask to reduce the dosage of the medication or replace the drug with another one.

Dizziness as a symptom

Feelings of spinning yourself in space or other objects around you, when everything is spinning, can often indicate dozens of dangerous diseases.

Fortunately, dizziness is not their only symptom, and the disease is diagnosed based on the study of a set of symptoms. Below is information about which diseases may cause spinning sensations.

Ear diseases

What makes you dizzy if your ear hurts? The reason is that inflammation of the middle and inner ear also affect the functioning of the vestibular apparatus.

This is a special organ responsible for a person’s specific position in space, from which any inflammation or other disturbances in its function are necessarily accompanied by dizziness and disorientation.

Such disorders include otitis media, labyrinthitis, or inner ear injuries. Dizziness in such cases can occur with a sharp tilt of the head or torso.

With otitis media, the inflamed areas tend to increase in size and put pressure on inner ear where the vestibular apparatus is located.

At the same time, the brain receives erroneous signals about the person’s position in space, which causes a feeling of rotation. If you feel dizzy and have ear pain for the second day, consult an otolaryngologist.

How to treat this disease in such cases? You just have to find the real reason and remove it, that is, the cause of the inflammation process.

Labyrinthitis is inflammatory process the inner ear, which is in direct contact with the vestibular apparatus. The patient has severe dizziness for several days, there is congestion in the ears and a feeling of pressure, headache, as well as nausea and vomiting.

When you feel dizzy when eating food, especially hot food, and there is severe pain in the ear, this may be caused by inflammation of the inner ear.

Inner ear injuries are accompanied by impaired blood flow, rupture eardrum, increased pressure in the inner ear, mechanical damage statolith apparatus (part of the vestibular apparatus).

Either way, this leads to severe dizziness, nausea, vomiting and severe pain. These symptoms occur immediately after injury.

There are also pathologies associated with tumors near and directly in the VA, damage to the vestibular nerve, etc. All of them are also accompanied by a feeling of losing oneself in space.

By the way, in in this case may be assigned.

Brain tumor

A tumor, malignant or benign, is a dense formation that puts pressure on nearby areas of the brain, thereby impairing blood circulation, causing disruption of the functions performed by these areas, the occurrence of edema and increased intracranial pressure.

If there is only one tumor and is localized in a zone of the brain distant from the center, then pathological symptoms often occur on one side - on the side where the neoplasm is located.

If a person has a brain tumor, they experience short attacks of dizziness, which are accompanied by an unpleasant feeling as if the ground is disappearing from under their feet, or a feeling of constantly falling.

If you often feel dizzy for no reason, the source of this illness may be a brain tumor, especially if it happens every day.

Meniere's disease

This disease is characterized by a sharp increase in the volume of fluid in the inner ear, which leads to an increase in intra-ear pressure. The disease can cause loss of balance, an unpleasant feeling of buzzing in the ears, and congestion.

Often accompanied by nausea and vomiting.

The most striking symptoms are observed from the musculoskeletal system. At first it is difficult for the patient to walk and navigate in space, then he loses the ability to move independently, his gait becomes unsteady.

All this is accompanied by severe dizziness.

Pathologies of the nervous system

In diseases of the nervous system, general weakness and slight dizziness are observed. There is almost never any nausea, loss of consciousness, increased heart rate, vomiting, or increased or decreased blood pressure.

If you constantly feel dizzy and everything is floating, but there are no other signs of pathology, the reason may be a disruption in the functioning of the nervous system. If this happens every day, you should consult a doctor. He must prescribe treatment.

Atherosclerosis

This disease is associated with increased level cholesterol. Plaques form from cholesterol on the walls of blood vessels, as a result of which the lumen of the blood vessels narrows and the blood supply to certain areas of the body deteriorates.

If cerebral vessels are narrowed by atherosclerotic plaques, a person experiences not just dizziness, but a feeling of loss of balance, he is constantly swaying, and can become dizzy at any moment.

The patient feels as if the ground is disappearing from under his feet, and he himself is constantly falling. In addition, atherosclerosis is accompanied by headache, increased blood pressure, nausea, and vomiting.

Skull injuries

These are serious mechanical defects that often damage not only the skull, but also the brain itself. This injury is accompanied by dizziness, unbearable pain and increased pressure inside the skull.

Nausea, vomiting and loss of consciousness are also often present. When a concussion occurs, a person experiences all of the above symptoms. Unfortunately, more serious damage often occurs.

Epilepsy

Manifestations of the disease are very diverse. In some cases this is seizures, in others (in case temporal lobe epilepsy) – severe dizziness.

Before a seizure, a person with epilepsy experiences dizziness, which is accompanied by numbness of the head and muscles responsible for facial expressions.

If you look closely at the patient, you will notice that his face is calm and his gaze is empty. After such a state, a seizure usually occurs.

In the case of temporal lobe epilepsy, dizziness, and not seizures, is the only symptom.

Multiple sclerosis

It involves inflammation of the nerve endings in the brain, causing the person to feel faint and dizzy in attacks.

Often accompanied by more severe symptoms: nausea, muscle weakness, impaired speech, hearing, vision, movement, skin sensitivity and so on.

Migraine

The disease is characterized by severe unilateral headache. But few people know that people who suffer from migraines also experience dizziness.

At the same time, it is felt more when the pupils move, when trying to say something, raise or lower the head, lie down or sit down. Any movement during migraine provokes intensification pain and dizziness.

According to statistics, migraines occur more often in women than in men.

Cervical osteochondrosis

It involves damage to the cervical vertebrae and intervertebral discs. Often, after sleeping in uncomfortable position, people suffering from osteochondrosis experience severe dizziness throughout the day.

And you feel dizzy with this disease because they can be damaged nerve endings, passing in the disks.

Vascular pathology

Both a strong narrowing and an increase in the diameter of blood vessels contribute to the occurrence of dizziness. When the blood vessels are overly narrowed, it is difficult for the heart to pump blood, and the body lacks oxygen.

The same symptoms are observed when blood pressure is too low, when a person may experience oxygen starvation. Such manifestations are often accompanied by dizziness, general weakness, sweating, nausea.

Loss of blood provokes a decrease in levels blood pressure, reduction in quantity blood cells, which are responsible for the delivery of oxygen, which is also accompanied by headaches and dizziness.

Anemia (decrease in hemoglobin and red blood cell count) is often accompanied by weakness, dizziness, and lethargy. Anemia can be congenital or acquired, for example, during long-term dieting for weight loss.

Gastrointestinal diseases

Abdominal pain and dizziness may be the first symptoms severe poisoning, dysbacteriosis, intestinal infections, malabsorption of beneficial components from food.

One of the manifestations of this type of pathology is.

Other diseases

Dizziness may also be a sign diabetes mellitus, diseases optic nerve, vitamin deficiency, heart disease, stroke, Parkinson's disease, thrombosis, etc.

Often this symptom is combined with others, and to diagnose the disease it is important to evaluate the entire range of clinical symptoms.

Dizziness often occurs in women when carrying a child, especially in the first months of pregnancy.

Women may also feel dizzy during menstruation or for 1-2 days after ovulation.

There are dozens of illnesses that cause dizziness, and it is difficult to determine which one caused this illness based on this complaint alone. The doctor takes into account the complex of signs of the disease and the dynamics of the patient’s condition.

There is also dizziness, which is actually caused by ordinary events, actions that do not harm a person. This, for example, is a ride on a carousel or a ride in public transport, severe stress, exhaustion, starvation, climbing to altitude.

Prolonged dizziness

What to do if you feel dizzy for a long time?

It is necessary to consult a doctor if, along with dizziness, a complex of painful symptoms is detected, such as headache, nausea and vomiting, poor coordination of movements, sweating, exhaustion, lethargy and others.

If you feel dizzy, but there are no other symptoms, then it is best to drink coffee, lie down, take a deep breath and lie there for five minutes with your eyes closed.

We hope that our article helped you figure out what to do if you feel dizzy. If so, rate the post 5 stars and share the post on social networks!

Weakness (on the verge of loss of consciousness).
Blurred consciousness.
Feeling of instability.
Lostness, disorientation in space.

Dizziness is a false sensation of body movement or environment in space. As a rule, the imaginary movement is of a rotational nature, but some patients experience a sensation of unidirectional movement to the side. Dizziness is only a symptom, not a diagnosis.

Both dizziness and unsteadiness may be accompanied by nausea and vomiting, as well as gait disturbances.

Sometimes it is difficult for patients to accurately describe the sensations, so they most often use the terms “dizziness”, “unsteadiness”, and often different patients people with the same disease describe symptoms differently. Sometimes even patients can describe the same “dizziness” in different ways. different time depending on how the question is posed. Therefore, despite the fact that patients distinguish between dizziness and gait instability as two different symptoms, doctors still combine them into one.

It should be noted that dizziness and unsteadiness can cause significant discomfort and reduced quality of life, often accompanied by nausea and vomiting. And in some situations they can be dangerous depending on the type of activity of the patient: driving a car, piloting an airplane, operating industrial vehicles.

Dizziness occurs in 5-6% of cases. May have temporary or chronic course. Chronic dizziness is considered to last for more than 1 month.

Pathophysiology of dizziness

The vestibular system is the most important department nervous system responsible for balance. It includes the vestibular apparatus of the inner ear:

VIII pair of cranial nerves, which transmits impulses from the vestibular apparatus to the central sections.
VIII cranial (vestibulocochlear) nerve, which transmits signals from the vestibular apparatus to the central elements of the system.
Vestibular nuclei located in the brainstem and cerebellum.

Damage to the inner ear and vestibular-cochlear nerve refers to peripheral system, and damage to the vestibular nuclei and pathways in the brainstem and cerebellum are central.

Visual perception and the proprioceptive signal coming from the peripheral nerves(via the spinal cord). These signals enter the cerebral cortex from the lower centers, which allows us to perceive body movements in space.

Vestibular apparatus

The vestibular apparatus is responsible for balance, body orientation in space and movement.

The vestibular analyzer consists of

3 semicircular canals,
2 otolith organs - elliptical and spherical sacs.

Rotational movements set the endolymph in motion semicircular canals, located in the plane of motion. Depending on the direction of the current, endolymph stimulates or inhibits the activity of hair receptor neurons located in the canal. Identical hair cells cover a matrix of calcium carbonate crystals (otoliths) in the spherical and elliptical sacs. The deviation of otoliths in space stimulates or inhibits the neuronal signal from hair receptors.

Causes of dizziness

Disorders of the peripheral vestibular apparatus:

Causes		Diagnostic tactics
Benign positional vertigo	The appearance of severe, short (less than 1 minute) dizziness in response to moving the head in a certain direction. Duration of nystagmus is 1-10 seconds. Nystagmus is exhaustive, rotational, directed towards the affected ear. Frenzel lenses must be used to prevent eye fixation. On examination there are no signs of hearing loss or neurological disorders	Dix-Hallpike test for diagnosing typical positional nystagmus
Meniere's disease	Recurrent complaints of tinnitus, hearing loss, ear congestion	Audiology and contrast-enhanced MPT are used to rule out other conditions.
Inflammation of the vestibular nerve	Sudden severe dizziness with loss of ability to work without signs of hearing loss. Duration up to 1 week. with gradual disappearance of complaints. Positional vertigo may develop	Clinical examination. MPT with contrast
Labyrinthitis (viral or bacterial)	Hearing loss, tinnitus	Carrying out a CT scan temporal bone for the purpose of exclusion infectious inflammation. Conducting MRI with contrast in case of complaints of unilateral hearing loss and tinnitus
Otitis media (acute, chronic, cholesteatoma)	Complaints of ear pain, detection of pathology during otoscopy (including the presence of discharge in chronic otitis media). History of infectious inflammation	Clinical examination. In case of cholesteatoma, CT examination is used to exclude damage to the semicircular tubules
Trauma (tympanic membrane perforation, temporal bone damage)	History of trauma. Diagnosis of other damage	If necessary, conduct a CT scan
Acoustic neuroma	Slowly progressive hearing loss, tinnitus, dizziness, imbalance, less commonly numbness in the face, weakness	Audiogram. MRI with contrast is indicated in the presence of unilateral tinnitus or bilateral hearing loss with to varying degrees on the ears
Ototoxic drugs	Reception of aminoglycosides, accompanied by bilateral decline hearing and vestibular disorders	Clinical examination. Application of electronystagmorrhaphy and Barany test
Ramsay Hunt syndrome	Simultaneous damage to the geniculate nucleus, accompanied by loss of taste and sensation in the facial area. Dizziness is possible, but not typical. Presence of vesicles on auricle and in the external auditory canal	Clinical examination
Chronic diseases musculoskeletal system	The appearance of symptoms after the acute inflammation musculoskeletal system	Clinical examination

Disorders of the vestibular apparatus of central origin:

Causes	What should the doctor pay attention to during the examination?	Diagnostic tactics
Spinal cord hemorrhage	Sudden manifestation. Damage to the cochlear artery can lead to ear complaints
Brain hemorrhage	Sudden onset with ataxia or other cerebral disorders is often accompanied by headache. Progressive deterioration	Immediate visualization. It is possible to use MRI with contrast or CT examination
Migraine	Episodic, recurring dizziness, not accompanied by hearing loss. A history of migraine (often a strong family history). Fear of light and sound. These symptoms help in making a diagnosis	Carrying out instrumental studies helps to install possible reason diseases. Migraine prevention
Multiple sclerosis	Damage to motor and sensory neurons of the central nervous system with periods of remission and exacerbation	Conducting MRI with contrast of the spinal cord and brain
Vertebral artery dissection	Patients often complain of pain in the head and neck area
Vertebrobasilar insufficiency	Short intermittent episodes, sometimes accompanied by blurred vision.	Magnetic resonance angiography

Significant dysfunction of the central nervous system:

Causes	What should the doctor pay attention to during the examination?	Diagnostic tactics
Anemia (for a number of reasons)	Pallor, weakness, sometimes blood in the stool	SBC
CNS-active drugs (non-ototoxic)	Recent Use medicines or increasing the dose, using several drugs at the same time, especially in elderly patients. Symptoms not related to movement or changes in body position	Sometimes the amount of drug (some anticonvulsants). Attempt to discontinue the drug
Hypoglycemia (usually caused by diabetes medications)	Increasing the dose of the drug in Lately. Sometimes excessive sweating is possible	Rapid finger prick blood test for sugar (if possible during symptoms)
Hypotension (caused by heart disease, antihypertensive drugs, blood loss, dehydration, or orthostatic hypotension syndrome, including orthostatic postural tachycardia syndrome)	Symptoms that occur with vagal stimulation (such as urination) but do not occur with head movement or lying down. Manifestation of symptoms for a variety of reasons (eg, blood loss, diarrhea)	Orthostatic vital statistics, sometimes when performing a verticalizing orthostatic test, ECG. Other studies should be performed as indicated.
Hypoxemia (for a number of reasons)	Tachypnea. Often a history of lung disease	Pulse oximetry

Other reasons:

Causes	What should the doctor pay attention to during the examination?	Diagnostic tactics
Pregnancy	May not be recognized	Pregnancy test
Psychiatric disorders (eg, panic attacks, hyperventilation syndrome, fatigue, depression)	Chronic symptoms that recur. Not related to movement or body position, but may occur during stress or upset. Upon examination, there was no pathology from the nervous system or ENT organs. The patient may be initially diagnosed with dysfunction of the peripheral part of the vestibular apparatus	Clinical examination
Syphilis	Chronic hearing loss on both sides with episodes of dizziness	Syphilis test
Diseases thyroid gland	Change in body weight. Intolerance to cold or heat	Thyroid function test

There are a large number of causes of damage to the vestibular apparatus: structural (trauma, tumors, degenerative processes), vascular, infectious, toxic (including drug intoxication) and idiopathic, but only in 5% of cases the cause can be a serious illness.

The most common reasons:

Dizziness
Meniere's disease.
Vestibular neuronitis.
Labyrinthitis.

The central part of the vestibular apparatus is less commonly affected; such diseases have a pronounced effect on brain functions, mental disorders, possible damage to visual or proprioceptive transmission. Sometimes it is not possible to diagnose the causes of such conditions.

The most common causes of staggering without dizziness are not as obvious, but are usually unrelated to the ear and are most likely related to:

exposure to drugs,
multifactorial or idiopathic in nature.

Often severe neurological disorders manifest with disturbances of orientation in space (or unsteadiness of gait), less often with dizziness. At the same time, a deficiency of elements such as oxygen and glucose occurs in the blood. Conditions such as hypoxemia, hypoglycemia, hypotension or anemia develop. Row hormonal changes may also cause dizziness (thyroid disease, pregnancy). Taking various groups of drugs that act on the central nervous system may be accompanied by dizziness, without having a toxic effect on the vestibular apparatus.

Unsteadiness and dizziness can also be psychogenic in nature. Panic attacks, hyperventilation syndrome, depression, psychosis may be accompanied by symptoms of dizziness.

Dizziness assessment

Anamnesis. When collecting an anamnesis of the present disease, it is necessary to accurately find out all the patient’s feelings regarding the existing symptoms; it is important to construct questions correctly (for example, “All people have different meanings for the word “dizziness,” could you describe in detail your feelings at this moment?”). Patients cannot always find the exact words, so you can sometimes suggest the necessary phrases (loss of balance, slight staggering, gait disturbance, etc.).

For more accurate diagnosis The following facts need to be clarified:

Severity of the initial attack.
The severity and frequency of subsequent attacks.
Episodicity and duration of attacks.
Episodicity, frequency and duration of attacks.
Which factors aggravate and which reduce symptoms (for example, changes in head/body position).
Presence of warning symptoms.
The severity and course of the disease.

It is necessary to clarify the nature of the attacks of dizziness: isolated, sudden, acute, or is it constant and recurrent? Was the first attack the most severe (vestibular crisis)? You should ask the patient in detail whether the symptoms change with head movements, when standing up, in stressful situations and during menstruation. Important associated symptoms are headache, hearing loss, tinnitus, nausea and vomiting, vision loss, and difficulty walking. It is necessary to assess the impact of attacks on the patient’s quality of life; to do this, you need to find out whether the patient has fallen, missed work, refuses to drive a car, etc.

Review of other organ systems should primarily include examination of the cardiovascular system (chest pain and/or palpitations), respiratory system (breathing problems), gastrointestinal tract (blood in the stool), endocrine system(heat or cold intolerance, changes in body weight, thyroid disease).

When studying the history of past illnesses, you should pay attention to head injuries (usually not difficult), the presence of migraines, diabetes, heart and lung disease, alcohol and drug use. You should also find out what medications the patient took, the duration of treatment and dosage.

Examination of the patient. The examination of the patient should begin with measuring heart rate, body temperature, respiratory rate, measuring pressure in a standing and lying position, and pay attention if the pressure drops in a standing position (orthostatic hypotension). If the symptoms of the present disease worsen in a standing position, it is necessary to compare them when moving the head, for this you need to return the patient to a horizontal position until all symptoms disappear and begin to rotate the head.

It is especially important to pay attention to the examination of the nervous system and ENT organs. Availability should be checked spontaneous nystagmus in a lying position, its duration and direction (for full description methods for studying nystagmus). You should pay attention to the direction and duration of nystagmus and the appearance of dizziness.

It is necessary to check whispered speech, examine ear canals for the presence of pathological discharge and foreign bodies, assess the condition of the eardrum (inflammation, perforation).

Cerebellar function is examined using the finger-nose test, flank gait assessment and Romberg test.

Key facts. Particular attention should be paid to the following symptoms:

Pain in the head or neck area.
Ataxia.
Loss of consciousness.
Local neurological disorders.

Interpretation of the data obtained. Traditionally differential diagnosis It is based on detailed specifications leading symptom (for example, differentiating dizziness from mild staggering). However, given the different interpretations of the same symptom by patients, these data cannot be objective. For a more accurate diagnosis, one should rely on the time of onset of symptoms, triggers, associated symptoms, especially neurological and otological in nature.

Some symptoms are highly pathognomonic, especially those that differentiate between peripheral and central departments vestibular apparatus.

Peripheral symptoms: Ear manifestations (eg, tinnitus, ear congestion, hearing loss) usually indicate impairment peripheral part and are associated more with dizziness than with generalized imbalance. Symptoms are usually paroxysmal and severe. Long-term imbalance is rarely associated with peripheral dizziness. Loss of consciousness is not associated with imbalance due to peripheral vestibular pathology.
Central symptoms: ear complaints are rare, gait/balance disturbances are more common. Nystagmus is not inhibited by fixation of vision.

Survey. All patients with sudden attack Pulse oximetry and a blood sugar test should be performed, and women should also take a pregnancy test. Most doctors also recommend an ECG. Other studies should be prescribed depending on the results obtained, but in most cases, MRI with gadolinium contrast is indicated for patients acute attack headache, neurological symptoms or other signs of central nervous system damage.

At long-term persistence symptoms, an MRI with gadolinium contrast should be performed to rule out stroke, multiple sclerosis, or other central nervous system diseases.

For patients whose whispered speech is normal and no pathology of the vestibular apparatus was detected during the initial examination, it is still recommended to undergo audiometry and electronystagmography.

Laboratory tests are usually inconclusive, except in patients with chronic vertigo and bilateral hearing loss, when syphilis must be excluded.

Age-related features of dizziness

Slows down with age general processes in the body, leading to deterioration in the functioning of organs and systems. Examples include deterioration of twilight vision, degeneration of inner ear structures, and decreased sensitivity of proprioceptors. In older people age group there is a higher risk of developing cerebrovascular disorders and disorders of the cardiovascular system. The above changes can lead to imbalance. Patients in this age group are more often prescribed antihistamines, cardiotropic, and antihypertensive drugs.

Patients in the older age group suffer from imbalance and dizziness much more severely than others. At this age, the risk of falling and fracture is higher, as a result of which a fear of moving develops, which significantly reduces the quality of life of these patients.

Along with treatment of the underlying disease positive effect Physical therapy and exercise can help.

Treatment of dizziness

Treatment is aimed directly at eliminating the cause, including stopping, reducing the dosage or changing the drug causing the described symptoms.

When vestibular disorders occur against the background of an attack of Meniere's disease, inflammation of the auditory nerve or labyrinthitis, the most effective drugs diazepams are considered (2-5 mg every 6-8 hours, higher doses must be used with caution, because there is a high risk severe dizziness) and anticholinergic drugs. In case of nausea while taking medications, the administration of prochlorperazine at a dose of 10 mg IM or rectal suppositories 25 mg. An attack of dizziness that occurs against the background of benign paroxysmal vertigo is stopped using the Eple maneuver (movement of otoliths). Patients with Meniere's disease should be observed by otorhinolaryngologists with extensive experience in treatment of this disease. However, along with this, it is necessary to follow a low-salt diet while taking potassium-sparing diuretics.

In patients with persistent or recurrent dizziness due to unilateral lesions of the vestibular apparatus, physiotherapy is successfully used. However, at an older age positive dynamics and stabilization of the condition is more difficult to achieve than in younger patients.

If you sway (sway) when walking, or are overcome by a feeling of a “floating” environment, then most often the root of the disease lies in vegetative-vascular dysfunction (VSD), pathological processes in departments spinal column, pressure surges, head injuries, multiple sclerosis, stroke.

Unsteadiness of gait in vascular and autonomic disorders

Often, unsteadiness of gait is directly related to vascular headaches, which manifest themselves against the background of disturbances in cerebral blood flow. Vascular cephalgia is characterized by:

localization in the occipital part;
exhausting, strong and throbbing pain radiating to the temples;
a feeling of unreality, a feeling that the world around is “spinning” and “spinning”;
visual deviations, including flickering “grid” before the eyes.

Patients complain of fear open spaces, an irresistible desire to be near any support. Many people note that before going out they feel a heaviness in the head and muscle tension. Movements become clumsy and uncoordinated. Without visible reasons the head aches and spins, weakness sets in.

Factors influencing instability

Doctors note that uncertainty and swaying while walking with VSD are associated with the following reasons:

Firstly, with impaired consciousness. Main symptoms: vision becomes cloudy, the surrounding “picture” loses clear outlines and becomes foggy, dizziness, suffocation, and often the person is in a pre-fainting state.
Secondly, with constant thoughts of being unwell. They create an imbalance in the body. Patients often notice that when they forget about the pathology and their head is “clear,” the unsteadiness disappears.
Thirdly, with tightness and stiffness muscle fibers. Why are the muscles tight? Chronic stress, fear, and depression make them this way. Muscle mass necks and backs tense, limbs tremble, dizziness, coordination is lost.

How to improve the condition?

It is important to “get to the bottom” of the causes of blood pressure surges, panic attacks, unreasonable fears, etc. After all, the main factors of instability during VSD, fogginess and headaches, vertigo are hidden in the lability of the nervous system, constant stress-anxiety and depressive states.

You should follow the instructions not only of therapists and neurologists, but also contact psychotherapists or psychiatrists with the problem. You will have full information about the causes of the malfunction in the body and know what to do to eliminate the “provocateurs” of the disease. Please note that almost 10% of gait imbalance and head ailments in VSD are associated with thyroid dysfunction and cardiac arrhythmia.

Balance imbalance in cervical osteochondrosis

If the gait becomes stumbling, with “drunk” elements, and at the same time the head is dizzy and noisy, then the pathology may be caused by collar (cervical) osteochondrosis. Unstability, loss of balance and swaying are accompanied by:

sensation of cotton plugs in the ears;
aching and lasting cephalalgia, which sharply intensifies with head movements;
soreness in the neck and face;
increased heart rate;
profuse sweating;
redness or pallor of the epithelium.

Effective ways to improve your condition

It is important to understand that regaining a confident gait without treatment cervical osteochondrosis, which provokes it, is impossible. Doctors may prescribe:

Taking pharmacological agents that dilate and tonic blood vessels, enhancing brain nutrition.
Do traction and fixation of the collar area, regularly water treatments, perform a complex (individually selected!) of physical therapy.
Stick to a diet enriched with vitamins B, C, etc.

A visit to the doctors should not be postponed if the lethargy of the legs is rapidly progressing. It is necessary to conduct a full and comprehensive examination so as not to leave unattended anomalies that require immediate surgical intervention. For example, a herniated (prolapsed) intervertebral disc pinching nerve tissue can sharply worsen the condition.