Vestibular crisis treatment. Vestibular crisis causes treatment Diagnosis of vegetative-vascular dystonia

Vascular crisis is a pathological condition accompanied by a violation in the vascular system of the human body. The disorder may occur in the central or peripheral circulation. This disease can occur at any age. It is equally common in both women and men.

Recently, cases of vascular crisis have become more frequent at a young age. This worried doctors, as a result of which they devoted a lot of time to studying and understanding the mechanism of the appearance of this disease.

A vascular crisis can occur as a result of the development of a serious illness in the body. Most often, it is one of the characteristic symptoms of the following series of diseases:

• Raynaud's disease
• Quincke's edema (angioneurotic edema)
• autonomic paroxysms
• congenital heart disease
• arterial hypertension
• angiotrophoneurosis
• hypertension

In addition, the following can serve as the cause of the development of a vascular crisis:

1. An imbalance in the body of vasoactive substances (secreted by vascular endothelial cells), as well as changes occurring in the receptor apparatus of the vessels.
2. Changes in the structure of the walls of blood vessels, which leads to a violation of the elasticity of tissues and their natural functions.
3. Often this occurs as a result of inflammatory processes in the body, in violation of normal metabolism or atherosclerotic changes.
4. Hormonal changes in the body that accompany menopause, gynecological inflammatory diseases and puberty.
5. Pathological processes in the endocrine system, central and peripheral nervous systems.
6. Congenital and acquired defects of the cardiovascular system,.
7. Incorrectly selected therapeutic procedures for the treatment of various diseases. Vascular crisis acts as a consequence of improper treatment.
8. Inflammation of the nervous system.
9. Congenital pathology of the cervical aorta.

Sometimes it is quite difficult to determine the exact cause of the onset of an attack of a vascular crisis. This is especially difficult to do in the vegetative-vascular form of this disease, the mechanism of which is not fully understood. Among the known reasons for its development are:

• hereditary factor
• hormonal imbalance in the body
• emotional overload and repetitive stressful situations
• recent traumatic brain injury
• pathological changes in the nervous system
• disruption of daily routine

How does a vascular crisis occur?

The term "Crisis" refers to sudden and sudden changes in a person's condition and the subsequent rapid development of the disease. The crisis manifests itself most often in the form of an attack. With this disease, as a rule, there is a violation of blood circulation in tissues and organs.

As a rule, an attack appears in the following sequence:

1. Arise.
2. The vessels of the brain expand, which leads to a throbbing pain in the head.
3. The headache gets worse until it becomes dull and pressing. As a result, perivascular cerebral edema occurs and a vascular crisis occurs.

Moderate sinus bradycardia: first aid

It should be noted that the crisis occurs quickly. In some cases, the symptoms of this disease can be expressed quite clearly. Therefore, you must immediately consult a doctor for proper medical care. The patient often requires hospitalization.

A vascular crisis manifests itself as an attack, which on average lasts about 20 minutes. However, in most patients, it manifests itself individually and can last a longer time.

The first thing to do when symptoms of a vascular crisis appear is to call an ambulance, no matter where you are. The specialist doctor will conduct a visual examination and, if necessary, prescribe diagnostic tests. After that, he will select the necessary therapeutic treatment that will help you overcome the disease and get rid of its unpleasant symptoms. If necessary, the patient can be admitted to the hospital.

Classification of vascular crises

Depending on the nature of the pathological process in the body, 2 types of vascular crises are distinguished:

1. Regional or organ crisis, which is characterized by a local manifestation. Violation of blood circulation occurs in a specific area of ​​​​the body or in a specific organ.
2. A systemic crisis that occurs as a result of pathological processes in the peripheral circulation. It is accompanied by a sharp change in blood pressure and a violation of the normal rhythm of the heart.

There are the following types of regional crisis:

• Cerebral crisis, which is accompanied by a sudden change in blood pressure. This leads to disruption of normal cerebral circulation.
• Angiotrophoneurosis, which is accompanied by tissue edema and circulatory disorders.
• Angioedema, which is expressed in localized swelling of the subcutaneous tissue.
• Migraine, which is characterized by a change in vascular tone.
  In addition, the following types of systemic vascular crisis are distinguished:
• Hypotonic crisis (collapse), which is accompanied by a sharp and strong decrease in blood pressure. There is an excess flow of blood to a specific organ or tissue area.
• Hypertensive crisis, accompanied by a sharp increase in blood pressure. There is a slowdown, restriction or complete cessation of blood flow to an organ or a specific area of ​​tissue.
• Vegetative-vascular crisis, which is a paroxysm of polymorphic disorders of the autonomic system. When this pathology occurs, the autonomic structures and the central nervous system are activated.

Please note that the vegetative-vascular crisis is the most serious form of this disease. To date, there are 4 forms of this type of disease:

1. Hyperventilation crisis, which is accompanied by a sharp change in vascular tone and the appearance of an acute lack of air.
2. Sympathetic-adrenaline, which occurs as a result of a sharp increase in the activity of the sympathetic department of the central nervous system.
3. Vegetative-vestibular crisis - this type of disease often occurs as a result of development in the central nervous system.
4. Vagoinsular - the main cause of its occurrence is a violation of the normal functioning of the parasympathetic department of the central nervous system.

First aid for stroke and heart attack: what can and cannot be done before the ambulance arrives

What are the symptoms of a vascular crisis?

A characteristic sign of a vascular crisis is a sharp change in blood pressure (it can either increase or decrease). Please note that each type of this disease is accompanied by certain symptoms characteristic of it. Let's dwell on this issue in more detail.

A regional crisis is most often accompanied by the following symptoms:

• severe headache that comes on suddenly
• the appearance of noise in the ears
• photopsia (false sensation of light in the eyes)
• impaired coordination of movements and orientation in space
• dizziness, nausea and vomiting
• drowsiness
• migraines
• speech problems
• memory disorder

In some cases, this disease is manifested by a decrease in the sensitivity of the upper and lower extremities, which can turn into paralysis. This may indicate damage to the crisis of the brain. Only a timely visit to the doctor will avoid these unpleasant consequences.

Hypertensive crisis is accompanied by the following symptoms:

• a significant increase in blood pressure
• throbbing headache
• rhythmic noise that suddenly arises in the ears
• the appearance of black dots in the eyes
• redness of the skin of the face and neck
• nausea and vomiting that does not bring relief to the patient
• tremor of the limbs
• feeling short of breath

The main symptoms of a hypotensive crisis are:

• a sharp drop in blood pressure
• strong
• feeling of great weakness
• profuse sweating
• tremor of the limbs
• constant ringing and tinnitus
• sweat on forehead
• pallor of the skin

The manifestation of the vegetative-vascular crisis are the following symptoms:

• sharp pains in the region of the heart
• an increase or, conversely, a slowing of the heartbeat
• lack of air
• sudden changes in blood pressure
• fever, chills, or sweating
• tremor and numbness of the limbs
• nausea, which may be accompanied by vomiting
• fainting
• severe dizziness
• rapid breathing
• the appearance without any apparent reason of feeling panic attacks or "fading" of the heart
• general weakness

As can be seen from the above, the most unpleasant symptoms accompany the vegetative-vascular crisis. The patient feels weakness, causeless panic and a sense of fear. After such an attack, he may be afraid to be alone and live in constant fear of a repetition of such an attack. However, this condition only aggravates the disease and provokes an early recurrence of a new attack, which may be accompanied by tremors of the limbs, frequent urination and severe headache.

If the above symptoms appear, you should definitely consult a doctor for diagnostic tests, confirmation or, conversely, refutation of the diagnosis - a vascular crisis.

Diagnosis and treatment

When diagnosing a vascular crisis, the first task that the doctor sets himself is to exclude the development of pathologies of the cardiovascular system in the body. The doctor measures the patient's blood pressure and conducts a general analysis of the clinical picture. In addition, it is appointed:

• vascular conditions
• laboratory diagnostics
• study of the brain by magnetic resonance imaging (MRI)

Only after all the necessary diagnostic studies have been carried out, the doctor decides what treatment is required to eliminate the disease that has arisen. For successful treatment, it is necessary to strictly follow all the doctor's instructions.

How does a vascular crisis manifest itself in older age

Most often, older people are diagnosed with a hypertensive crisis. At this age, it manifests itself with the following symptoms:

• increased heart rate and heart rate
• cerebral vessels
• carotid artery injury
• severe increase in blood pressure
• the appearance of a hypokinetic type of blood circulation
• hypersensitivity to salt

For this type of crisis, the absence of a sudden onset of an attack is characteristic. The disease develops gradually, the relapse lasts for quite a long time.

Is it possible to cure a vascular crisis in one day?

The unequivocal answer to this question is no. To get rid of the disease and prevent the occurrence of new attacks, it is necessary to undergo a full course of drug treatment and therapeutic procedures. Their duration depends on the nature of the disease and the individual characteristics of the patient.

Prevention of vascular crisis

To prevent the onset of a vascular crisis, you should follow these important recommendations:

Thus, a vascular crisis is quite common and requires immediate treatment. It is accompanied by a number of unpleasant symptoms, which not only significantly reduce the quality of life of the patient, but also contribute to the development of other concomitant diseases.

Feb 4, 2017 Violetta Doctor

vestibular crisis- a syndrome characterized by dizziness, tinnitus, vestibulo-vegetative reactions.

Etiology and pathogenesis of vestibular crisis. Atherosclerotic lesions of the vertebral and basilar arteries, arachnoiditis, labyrinthitis and some other diseases.

Clinic of vestibular crisis. The disease is manifested by transient dizziness, tinnitus, vestibulo-vegetative reactions. Orientation in space is disturbed, extremely intense dizziness occurs, causing a sensation of movement of one's own body, head or surrounding objects. At the height of the attack, nausea and vomiting may occur.

The patient takes a forced position - lies motionless with his eyes closed, because even the slightest movement provokes dizziness, the appearance (intensification) of nausea, tinnitus, hearing loss.

Vestibulo-vegetative reactions are manifested by nystagmus, impaired muscle tone, the appearance of discoordination of movements and the appearance of a specific unsteady gait.

To reliable diagnostic methods include otoneurological tests. Differential Diagnosis carried out with cerebellar disorders.

Emergency care for vestibular crisis.

This condition does not pose a direct threat to life. Treatment should be aimed at the underlying disease and the elimination of neurological and psychopathological syndromes (relanium), by improving cerebral circulation and metabolic processes (cavinton).

• 1 Causes of the disease
• 2 Symptoms of the disease
  • 2.1 Vegetative-vascular
  • 2.2 Hypertensive
  • 2.3 Hypotonic
  • 2.4 Cerebral crisis
  • 2.5 Angiotrophoneurosis
  • 2.7 Migraine (headache)
• 3 Methods for diagnosing a vascular crisis
• 4 Treatment of the problem
• 5 Possible consequences
• 6 How to warn?

A serious and common disease is a vascular crisis. The problem requires immediate and competent treatment under the strict supervision of a doctor. The disease is supported by a large number of unpleasant symptoms that adversely affect human life and cause new pathologies. Taking the right preventive measures will help prevent the problem from developing.

Causes of the disease

A vascular crisis is a state of a sharp change in blood circulation in the vessels with a violation of the strength of the blood flow. With a vascular crisis, the causes of development are as follows:

• disruption of the vessels related to the central nervous system, vascular pathology;
• hypertonic disease;
• congenital abnormalities;
• change in the density of the structure of the vascular wall;
• problems in the work of the endocrine system;
• hormonal imbalance;
• hereditary disposition;
• psycho-emotional stress;
• head injury.

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Symptoms of the disease

Vegetative-vascular

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Hypertensive

Headache, tremor, nausea and vomiting are typical symptoms of a hypertensive crisis.

Hypertensive crisis occurs due to a significant increase in diastolic and systolic blood pressure. The characteristic symptoms include pain in the head with throbbing sensations localized at the back of the head, background noise in the auricles, ripples in the eyes. The skin in the neck and face are covered with red spots, ruptures of blood vessels in the eyeballs are recorded. Extra movements cause discomfort, such as nausea and vomiting, tremors of the limbs, shortness of breath.

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hypotonic

A characteristic phenomenon for this variety is a decrease in the value of blood pressure. A rapid decrease causes nausea, dizziness, lethargy. Characteristic signs are trembling in the limbs, cold sweat, darkening of the eyes, severe weakness, thermorrh of the limbs. Hypotonic vascular crisis causes constant ringing in the auricles, blanching of the skin, the presence of perspiration on the forehead.

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cerebral crisis

Cerebral vascular crisis is formed by changing the vessels of the brain in an atherosclerotic way, characterized by a sudden pain in the head and a violation of the vestibular apparatus. Nausea, discoordination of movements are inherent in this crisis. The crisis is accompanied by disorientation, memory impairment and drowsiness. Increased susceptibility to sound stimuli and movement, as well as dazzling light. A complicated attack forces a person to protect himself from any noise stimuli that provoke severe headache.

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Angiotrophoneurosis

Angiotrophoneurosis is not considered a pure type of cerebral vascular crisis. The vessels are characterized by a rapid change in spasm and expansion in a specific segment of the body, most often these are the fingers. This is facilitated by a violation of innervation. Over time, the processes become permanent and provoke dystrophy in the tissues, due to which the pathology is already considered as an independent disease. Therefore, only the initial manifestations are related to angiotrophoneurosis.

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This type has a strong connection with deviations of an allergic nature, its manifestation is fixed by the release of a significant amount of serotonin in the tissues. At the same time, swelling is observed in certain areas of the skin, an increase in the size of the injured parts of the body. A distinctive characteristic of this species is the absence of itching and discoloration of the skin and mucous membranes.

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Migraine (headache)

The appearance of migraine is characterized by a change in vascular tone from the initial spasmodic attack to vascular expansion. In this situation, swelling of the brain tissue is observed, irritability, throbbing pain, which eventually turns into pressing pain, which covers only one half of the head, become characteristic.

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Methods for diagnosing a vascular crisis

Diagnosis of cerebral vessels begins with checking for problems of the cardiovascular system. The exclusion of these ailments, the study of the vitality and characteristics of the disease, the conduct of instrumental and laboratory tests makes it possible to diagnose a vascular crisis. The main study tools include blood pressure readings, the study of thyroid hormones, ultrasound of the vessels, if necessary, the doctor can send the patient to do MRI or CT diagnostics.

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Treatment of the problem

Treatment includes not only medication, but also diet and exercise.

To treat a brain crisis, regardless of its type, is required immediately. The main step on the path to healing is an urgent appeal to a specialist for help. Based on the tests completed and the description of the symptoms, the doctor will prescribe the appropriate drugs to treat the problem, which will help prevent the recurrence of seizures. Self-medication in this case is categorically contraindicated, the consequences of illiterate treatment may be irreversible. In addition to drug treatment, diet, physical activity, and hardening of the body are important.

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Possible consequences

The consequences of crises depend on the level of dystonia and the development of the disease. The result of an exacerbation of the VVD may be disability or the possibility of death. An increased level of blood pressure leads to the possibility of a stroke or heart attack, tachycardia can provoke cardiac arrest, panic attacks and psycho-emotional overload cause inappropriate actions. First aid, at home, is a rather problematic task, so it is recommended to immediately call an ambulance.

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How to warn?

Preventive measures will help prevent a vascular crisis:

• following the correct daily routine;
• regular physical activity (aerobics, swimming);
• daily walks in the fresh air (minimum 2 hours);
• the use of sedatives in the presence of psycho-emotional stress;
• elimination of negative psychological influences and their consequences from life;
• giving up bad habits.

The crisis becomes a serious and common disease in a stressful environment caused by the fast pace of life. There are many varieties of crisis that a person cannot distinguish on his own. Therefore, the patient needs an immediate consultation with a specialist, which is important for determining a high-quality and effective method of treatment and preventing recurrence of a crisis.

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What is an aortic aneurysm and how is it treated?

Aortic aneurysm is defined as a condition that is accompanied by the appearance of a saccular dilatation in the vessel. Symptoms are usually mild or absent at all. Pathology is the result of the influence of various factors, in particular, atherosclerotic lesions and syphilis, vascular injury, and so on. If the patient does not take any action, the consequences will be sad. Therefore, it is important to undergo examinations on time and follow medical recommendations.

General characteristics of the violation

The largest vessel in the body is the aorta. Under certain circumstances, a protrusion, or expansion, of the aorta, which has a sac-like shape, is formed in one of its sections. Such a deviation is called an aneurysm.

In most cases, no signs indicating the formation of this disorder are observed. An aneurysmal dilatation may be discovered unexpectedly during examination when a person comes to the doctor with suspicions of a specific disease. In addition, a pathological protrusion of the vessel is detected if the patient complains of symptoms that were the result of compression of the adjacent organs and tissues by the formed aneurysm.

In an aneurysm, the elastic fibers in the media are destroyed, resulting in the remaining fibrous tissue being stretched.

Then, respectively, happens:

• an increase in the diameter of the aorta;
• an increase in stress in its wall.

Since the process is prone to progression, further expansion of the lumen increases the risk of rupture of the formation.

The larger the pathology becomes, the sooner the rupture will occur and internal hemorrhage will begin. The patient may experience shock and then die.

If an aortic aneurysm appears, you need to know what it is and how it is formed.

Pathology is caused by:

1. Damage to the vascular wall.
2. mechanical pressure.
3. Direction of blood flow.

If the main artery is healthy, it will withstand the rapid increase in blood pressure that accompanies a hypertensive crisis. However, when the wall becomes thinner, when blood is ejected, it simply bulges out. In the sac that has formed, there is a change in the course of the blood flow. Its entry into the cavity and constant movement in it seriously worsens the situation. Knowing what an aortic aneurysm is, it is important to immediately start treatment at its first manifestations. Postponing the elimination of violations, you can lose your life at any time.

Factors causing deviation

Aortic aneurysm, being a rather dangerous disease, can have a variety of causes.

Doctors explain the appearance of pathology by the presence of:

• atherosclerosis. So far, it has not been possible to fully understand how atherosclerotic disease proceeds, due to which an aneurysm of the abdominal aorta develops. There are suggestions that due to atherosclerosis, characteristic changes occur in the inner lining of the main artery. That is, the supply of nutrients and oxygen is disrupted. The tissues are damaged and split, which, accordingly, determines the occurrence of pathological expansion.
• genetic factors. Patients with Ehlers-Danlos or Marfin syndromes, as well as other hereditary pathologies, are prone to weakening of the walls of the arteries, including the aorta.
• Infectious damage. In patients suffering from endocarditis or syphilis, the inner heart layer may be affected, causing the aorta to dilate.
• age changes. As you know, with age, the vessels lose their elasticity, the aorta becomes rigid. Therefore, the risk of damage to a certain part of the aorta increases.
• Injuries. The vessel may suffer from a sudden blow, respectively, an aneurysm is not excluded.
• Inflammatory process. If there is inflammation in the aorta, its wall is weakened.

Most often, aneurysm is provoked by arterial hypertension, which, in turn, develops against the background of atherosclerotic disease.

Varieties of extensions

Aneurysms should be distinguished depending on:

• segmental location;
• forms;
• buildings;
• origin.

Classification by location distinguishes:

1. Damage to the thoracic aorta. There is an aneurysm of the ascending aorta, descending and arch.
2. Expansion of the abdominal artery.
3. Combined pathology.

The shape of an aneurysm can be:

1. Saccular. It is characterized by local bulging of the wall. Approximately 60% of patients have this form.
2. Fusiform. This is a diffuse proliferation of the aorta along the entire diameter. It can be confused with age-related sclerotic expansion.

If we talk about the morphological structure of the pathology, it happens:

• true. All layers of the vessel become thinner and protrude outwards. Most often, the violation has an atherosclerotic or syphilitic etiology;
• false. Pseudoaneurysm is the result of the formation of a hematoma (concentration of clotted fluid tissue), while the walls of the artery retain their integrity. False violations are often detected after injuries and surgical manipulations. In addition, their appearance is associated with vasculitis, or cancer, or fibromuscular dysplasia;
• exfoliating. After the rupture of the inner membrane, the blood enters between the layers and a new channel appears.

Since the etiology of the disease is quite extensive, the causes of an aortic aneurysm can be:

1. Congenital. This kind of protrusion is present due to an insufficiently formed vessel wall, a lack of proteins - elastin and collagen, due to which the aorta acquires density and elasticity.
2. Acquired. An aneurysm is provoked by infection (syphilitic, or fungal, or postoperative) and atherosclerosis, flaws in the suture materials used, and malfunction of artificial valves.

Since aneurysms proceed in different ways, it is necessary to say about the development of forms:

1. Uncomplicated.
2. Complicated.

Pathology can be complicated:

• rupture of an aneurysmal formation, in which massive internal bleeding and hematomas are observed;
• thrombosis and thromboembolism;
• aortic valve defects and heart failure;
• acute purulent inflammation of the tissues around the aneurysm.

The lethal outcome occurs due to tearing of the aneurysmal protrusion, its stratification, or after a complete violation of the integrity of the pathological formation.

Clinical picture

Aortic aneurysm, as already mentioned, the symptoms are often mild, which is why it is not immediately possible to understand that there is a pathology. However, it is important to notice certain violations in the state of the body in time in order to prevent serious consequences.

Signs of a developing aortic aneurysm will appear depending on its location.

If the thoracic region is affected, the patient suffers most from throbbing, aching and deep pain. Discomfort is similar to angina pectoris.

The occurrence of an extended section in the descending section is supplemented by:

• irradiation of pain in the shoulder blade on the left side and the area between the shoulder blades;
• damage to the vertebrae with nerve endings and the spinal cord;
• obstruction of the esophagus (in rare cases).

The pain syndrome due to pinched nerve roots is so intense that it cannot be removed even with the strongest painkillers. Some patients may lose the ability to freely move their lower limbs if the vertebral bodies are affected.

When the lung is compressed, pneumonia is not ruled out. A pinched esophagus causes dysphagia, in which food cannot move normally.

An aneurysm of the aortic arch, caused by syphilis, worries about severe pain at night. The timbre of the patient's voice becomes low, rough and even inaudible. The patient suffers from shortness of breath, which appeared as a result of the fact that the bronchi and trachea were clamped.

Symptoms of an aortic aneurysm are also observed in the form of:

• dry cough;
• bradycardia;
• salivation;
• congestion;
• frequent pneumonia.

Aneurysm of the ascending aorta is accompanied by:

• pain in the heart or behind the sternum (due to compression or stenosis of the coronary arteries);
• shortness of breath with tachycardia and dizziness (if there is an expansion of the aortic root);
• headaches;
• swelling of the face with the area of ​​the neck, arms and cervical veins.

When the pathology affects the abdominal aorta, most often the patient suffers from pain discomfort in the abdomen.

The disease is also recognized by:

1. Pain of a boring, aching or throbbing nature, localized in various parts of the body, for example, in the chest and lower back, legs and groin. Feelings can persist for hours or even days. Usually the nature of the discomfort remains unchanged during the movement, but in some position the patient feels somewhat better.
2. Pulsations in the abdomen.
3. Change in the color of the fingers (darken or turn blue) and their soreness, coldness of the feet. Symptoms occur during thrombosis, when blood clots break off, block the vascular lumen and interfere with blood flow to the lower extremities.
4. Decreased body weight and febrile state, which is observed with an inflammatory aneurysm.

The exfoliating form declares itself with signs in the form of:

• cutting pain that causes a slight physical effort and which radiates to the shoulder area and between the shoulder blades, abdomen and legs;
• severe shortness of breath and the absence of pain discomfort (more often observed in the elderly);
• a state of shock, resulting in fainting and convulsive manifestations, as well as a decrease in blood pressure.

If help is not provided in time for the rupture of the saccular formation, the victim will die.

This condition is accompanied by:

1. Sudden sharp pain in the chest or abdomen.
2. A sharp drop in blood pressure.
3. Tachycardia and respiratory failure, pallor and cyanosis of the skin. In a state of shock, the patient does not respond to pain, cannot move and answer questions.

Features of treatment

Before the treatment of an aortic aneurysm is prescribed, the patient must undergo an examination.

Diagnostics consists of:

• x-ray examination;
• Ultrasound of the largest artery and heart;
• computed tomography;
• aortography.

When diagnosing a pathology, the similarity of its manifestations with the symptoms of other ailments is certainly taken into account.

An aortic aneurysm that has appeared will have treatment depending on how large the formation has reached and how fast it is growing. If the aneurysm is large enough and continues to grow, the patient is prepared for surgery. Often, with such a clinical picture, the damaged part of the vessel is replaced with an artificial graft.

If the thoracic aorta is affected, the patient is operated on in the presence of an aneurysm with a diameter of 5.5-6 cm. If localized in the abdominal region, surgical elimination of the pathology with a diameter of up to 4 cm is indicated.

The absolute indication for surgery is aortic rupture. This is the only way to save the patient.

Rehabilitation can last a maximum of a month. The more successful the surgical procedure and the better the patient feels, the faster he will recover.

Treatment of small aneurysms involves the use of:

1. Drugs that lower blood pressure.
2. Medications that can reduce the load on the arterial wall.

If surgery was performed earlier, control over the growth of the pathological disorder is carried out using ultrasound.

When an increase and rupture of the saccular protrusion is excluded, this does not mean that the patient cannot face cardiac disorders.

In this case, it is written:

• performing therapeutic exercises;
• dietary diet.

You must completely stop smoking. In addition, drugs are prescribed that reduce cholesterol in the blood. If desired, you can use traditional medicine. True, it should be remembered that it will not replace the main treatment. Folk methods are designed to strengthen the vascular wall.

Useful recipes:

1. Dry hawthorn fruits (2 tablespoons) are poured into a thermos and boiling water is poured (2 cups). After 2-3 hours, the infusion is consumed half a cup before meals.
2. In the same way, an infusion of levkoy jaundice is prepared. You need to drink it before eating a tablespoon 4-5 times a day.
3. Arnica flowers (1 part) are mixed with St. John's wort (4 parts) and yarrow (5 parts). The collection is poured with cold water (1 glass) and left for 3 hours. Next, for several minutes, the medicine must be boiled. The cooled infusion is filtered and drunk during the day in several approaches.
4. Dill (grass or seeds) in the amount of one tablespoon is poured into a container and steamed with boiling water (1.5 cups). After insisting, use throughout the day.
5. The elderberry root (1 tablespoon) should be poured with a glass of water, boiled for 15 minutes and left to infuse for 30 minutes. It is recommended to drink the remedy 3 times a day for a tablespoon.

As medical practice shows, 50% of patients experience a rupture of a pathological formation throughout the year, which has grown to 6 cm in diameter. But thanks to modern surgical treatment, many patients can recover from the pathology, most importantly, do not delay going to the hospital.

Therapy of the consequences of a hypertensive crisis

Crisis conditions in arterial hypertension lead to severe complications, often irreversible. The consequences of a hypertensive crisis can be fatal if they are not diagnosed in a timely manner and the patient is not provided with qualified and comprehensive medical care.

Especially the crisis course of hypertension

Understanding the nature of the complication that can cause a sharply increased pressure is possible only against the background of understanding the features of the course of a crisis state in hypertension.

Crisis type

Clinical manifestations

Possible Complications

Complications after a crisis are caused by the fact that the sharply rising pressure disrupts the vascular circulation. Therefore, the consequences of such a condition are many, their manifestations depend on how timely and efficiently the patient was provided with the necessary medical care.

Causes of crisis vascular conditions

The main cause of a hypertensive crisis is considered to be consistently high blood pressure or its sharp jump. In addition, the main causes of hypertensive breakdown experts include:

• prolonged or sharp stressful conditions;
• abrupt change in weather conditions;
• increase in salt intake;
• passion for alcohol;
• the period of age menopause in women;
• cerebral asthma;
• disorders of cerebral circulation;
• symptoms of oxygen deficiency.

Against the background of these pathological conditions, palpitations, shortness of breath, tremor, severe dizziness, and severe vomiting are often manifested in the patient.

The most common manifestation of a hypertensive crisis is a sharp headache, which increases if the head turns to the side.

Possible consequences of a crisis state

Hypertensive crisis states can cause serious complications and consequences for the body. Depending on what disorders provoked an arterial attack, doctors determine an adequate first treatment. If a sharply increased pressure provoked dissection of the aortic aneurysm, then blood pressure should be reduced very quickly: within 10 minutes by 25 percent of the initial values.

In complex disorders of cerebral circulation, the pressure should be reduced slowly and carefully. In addition, a hypertensive crisis can provoke the following complications in the body:

• acute encephalopathy;
• acute myocardial infarction;
• unstable angina;
• acute cerebral infarctions;
• acute heart failure;
• pulmonary edema.

No less frequent manifestation of hypertension in old age is fixed and pressure surges without visible manifestations. A person feels well, does not complain about the deterioration of his condition, accidentally learns that his blood pressure indicators are far from normal. The "invisible enemy" is able to do his dirty work no less skillfully, so the complications in this course of hypertension are:

• myocardial infarction;
• severe disorders of cerebral circulation;
• ischemic or hemorrhagic stroke.

Causes of somatic disorders after a crisis

The main somatic manifestations of the consequences of hypertensive crisis conditions, doctors include changes in the vascular system.

1. After suffering a crisis, the patient often has pain and dizziness due to a pathologically narrowed vessel of the right vertebral artery. This state of vascular hypoplasia is considered a congenital pathology, but dizziness occurs against the background of insufficient blood supply to the brain.
2. Unstable blood pressure, which begins to fluctuate against the background of a crisis, can provoke frequent dizziness, nausea and vomiting.
3. Often the patient is bothered by pain in the head, especially in the upper part. This condition is accompanied by a feeling of fear, increased anxiety, panic attacks, when the earth spins and leaves from under the feet.
4. Low blood pressure often occurs in patients if the treatment is incorrectly adjusted or the doctor's prescriptions are not followed by the patient.

Regardless of what complications are diagnosed in a patient against the background of a vascular crisis, the treatment of post-crisis conditions should be entrusted to doctors, since self-treatment in such conditions is especially dangerous.

Complex diet therapy

After suffering a hypertensive breakdown, the patient should adjust the diet and lifestyle in general. Doctors recommend that their patients follow a special and balanced diet:

• the daily balance of consumption of fats, proteins, carbohydrates should be brought back to normal by adjusting the diet;
• it is worth reducing daily salt intake or minimizing it;
• avoid the consumption of alcoholic beverages, stop smoking tobacco;
• the menu should contain a sufficient amount of protein-containing products: dairy products, fish;
• normalize daily consumption of fresh vegetables, fruits, natural juices.

Specialists draw the attention of their patients to the fact that in the diet of a patient who has undergone a hypertensive crisis, there should not be coffee, strong tea, energy drinks.

Relapse therapy

The fact that after a therapeutic course aimed at eliminating the symptoms of a hypertensive crisis, the patient may retain characteristic symptoms, as a rule, frightens the patient. Some begin to believe that the pathology is returning, but doctors assure that in some cases this condition has only a psychosomatic basis.

1. A sharply increased pressure is diagnosed in patients often against the background of severe excitement or nervous stress. The unstable state of the vessels and cerebral blood supply, which continues for some period after the breakdown, is accompanied by complex symptoms: a person often feels dizzy, hurts in the back of the head, and presses on the temples.
2. Pressure for a certain period of time is accompanied by an instability syndrome: low is replaced by high, and vice versa.
3. Dizziness provokes a vestibular syndrome: nausea, vomiting, the earth is spinning and objects in the field of view.
4. A person begins to worry about obsessive symptoms, considering them the approach of a new crisis, nervous overstrain leads to new pressure surges and a relapse of the disease: the situation is spinning in a vicious circle.

The treatment of such pathological consequences is carried out by the therapist together with the psychologist, since complex symptoms are caused by psychosomatic disorders, but lead to physical vascular pathological changes and a repeated crisis. Timely and properly organized complex treatment prevents the recurrence of attacks and repeated hypertensive arterial breakdown.

Medical support

Treatment of the consequences of the crisis, especially in the presence of complications, is impossible without a drug course. What to do and which scheme will be most effective is decided by the doctor, who adjusts the appointments in accordance with the identified complicated processes.

The scheme according to which the treatment is carried out is adjusted by the attending doctor, the specialist sets the dosage and frequency of taking medications. The patient's task is to strictly follow the doctor's instructions, and not to ignore the recommendations of specialists on the way of life.

Life after the crisis

After the main treatment of the crisis condition is over, most patients find that they can safely return to their usual pace and lifestyle. However, experts draw attention to the fact that such a state of remission is not stable, any minor provocation can lead to a relapse of the disease and serious consequences.

The first few weeks after a hypertensive crisis, simple but important recommendations should be followed:

• possible physical activity, weight lifting are excluded, which is especially important for women;
• normalization of the psycho-emotional state, avoidance of stress loads and conflict situations;
• constant observance of the regime of work and rest, especially this rule applies to a full night's sleep;
• refusal to consume alcoholic beverages, including low-alcohol variants;
• reduce nicotine intake if possible or stop smoking cigarettes altogether;
• it is not recommended to do heavy work around the house: repairs, general cleaning, furniture rearrangement;
• it is not recommended to increase salt intake, despite the stabilization of the condition;
• in order to increase the patency of blood vessels, thereby avoiding repeated regular dizziness, it is desirable to establish a regular drinking regimen.

For people suffering from regular pressure surges, doctors recommend taking special medications daily. Such recommendations should not be ignored, the dosage prescribed by the doctor should also not be reduced or increased on your own.

To preventive measures that help prevent the recurrence of the disease and re-crisis, experts also include:

• exercise therapy recommended by the attending doctor;
• regular walks in the daytime and in the evening;
• at the first sign of an approaching attack, when you feel dizzy and dark in the eyes, you should do a massage or self-massage of the neck and the back of the head.

Crisis Prevention

Vascular pathologies, including crisis ones, are easier to prevent in a timely manner than subsequently to carry out their complex treatment.

1. It is recommended to pay attention to the prevention of hypertension, the sooner the better. This is especially true in cases where the hereditary predisposition to hypertension is passed down from generation to generation.
2. After a crisis, you should especially carefully listen to the signals of the body: headache, pressure in the temples and neck, spinning before the eyes and the ground is leaving from under the feet - all this is considered a reason to take pressure measurements and seek medical help.
3. Regular intake of drugs that help strengthen the venous walls and blood vessels will help prevent a sharp attack and pressure surges.
4. An important prophylactic moment is the self-regulation of the mental state by patients who have had an attack.

Prevention of hypertensive crisis conditions requires constant attention and compliance with all necessary preventive measures in the complex.

Recently, the topic of vascular disorders, in particular crises, has become more and more frequent. Considerable attention is devoted to these conditions on the part of physicians, which is reflected in the modern understanding of these conditions.

Etiology of vascular crises

Vascular crises do not occur without certain causes and conditions. More often they lead:

They are not, as such, the causes of crises, but critical and life-threatening conditions, such as various types of shocks, cause abrupt changes in vascular tone.

Important!Clinical manifestations of vascular crises are most often caused by several factors that reinforce each other's actions. Sometimes it is extremely difficult to determine the exact dominant cause, especially in the later stages of the disease, when many factors become equally weighty.

Classification of vascular crises

Initially, in the course of studying vascular crises as an independent disease, many approaches to classification were proposed.

The most common classification has recently become, dividing vascular crises into:

Clinical variants of vascular crises

An extremely important point to which particular attention should be paid is the rapid onset of clinical manifestations. Under certain circumstances, it can be quite pronounced and require the provision of medical care to the patient, often with subsequent hospitalization.

Systemic options for crises:

• hypertensive crisis
• hypotonic crisis (collapse);
• vegetative-vascular crises.

Non-systemic variants of crises:

• cerebral crisis
• migraine;
• angioedema;
• angiotrophoneurosis.

Symptoms of vascular crises depending on the types

Clinical manifestations of vascular crises can be:

• hypertensive crisis;
• hypotensive crisis;
• vegetative-vascular crises;
• cerebral crisis;
• migraine;
• angioedema;
• angiotrophoneurosis

Hypertensive crisis

A hypertensive crisis is characterized by a significant rise in systolic and diastolic blood pressure values ​​(very rarely, in some diseases, only systolic pressure may rise) with characteristic clinical manifestations. These include, first of all, a headache of a pulsating nature, more often in the occipital region, rhythmic noise in the ears, flashing black dots before the eyes.

The skin of the neck and especially the face becomes hyperemic, flushed with injected sclera. Frequent hemorrhages in the sclera of one eye. Any movements, unrest in this state lead to an increase in unpleasant sensations. Often there is nausea and vomiting, which does not bring relief to the patient, there may be trembling of the limbs or tremor, a feeling of lack of air, palpitations and pain in the region of the heart. As a rule, the pain is dull and of moderate intensity. Patients tend to reduce physical activity, often sit with their legs down.

Hypotonic crisis

Its main characteristic is a sharp drop in values. These conditions are accompanied by strong, weakness and dizziness, mild nausea, which, however, can rarely result in vomiting. The person feels like "failing or losing consciousness."

There is always profuse sweating, trembling in the arms and legs. For a person, a change in posture becomes characteristic: a standing person smoothly squats down “slides down the wall”, and a sitting person lies down. A hypotonic vascular crisis is characterized by constant noise and ringing in the ears, a sharp pallor of the skin and constantly occurring perspiration on the forehead.

Vegetative-vascular crises

Vegetative-vascular crises can manifest themselves in the form of:

• Sympathetic-adrenal type of vascular crisis- occurs with a sharp increase in the activity of the sympathetic department of the central nervous system and an increase in the level of catecholamines, mainly adrenaline and norepinephrine. Such patients are excited, restless, active. These crises are accompanied by a strong sense of anxiety and fear. Palpitations are characteristic - tachycardia, severe chills, headaches and chest discomfort. The limbs are dry and cold to the touch.
• Vago-insular type of vascular crisis- associated with the predominance of the influence of the parasympathetic department of the central nervous system. The main manifestations are profuse sweating, weakness, tinnitus, increased intestinal motility, severe nausea. From the side of the heart - interruptions in the work of the heart.
• Hyperventilation type of vascular crisis- is characterized by the fact that in response to a slight change in vascular tone, an acute lack of air appears, leading to a significant one (tachypnea). Often noisy breathing quickly causes hyperventilation, tachycardia, sweating and a kind of tetany - a strong spasm of the muscles of the upper extremities.
• Vegetative-vestibular type of vascular crisis- observed most often in the presence of pathology from the central nervous system, such as: head trauma, stroke, encephalopathy, as well as in some types of ENT diseases. The main manifestations in this case are severe dizziness, nausea, impaired coordination of movements, quite often - the inability to walk and navigate in space.

cerebral crisis

In the vast majority of cases, it develops against the background of atherosclerotic changes in the vessels of the brain and is accompanied by a sharp headache and vestibular disorders, nausea and repeated vomiting, dizziness, as well as violations of small precise hand movements. Often this type of regional crisis is accompanied by agitation, dysmnesia or memory disorders, partial disorientation and general drowsiness with a persistent inability to fall asleep.

Significantly increased sensitivity to sharp and loud sounds, as well as to bright light. In severe cases, patients try to be alone in a room with subdued lights, as ordinary speech, a working TV or radio causes them a severe headache.

Migraine

Migraine is characterized by a change in vascular tone from the initial spasm to expansion. At the same time, a pronounced perivascular (perivascular) edema of the brain tissue was experimentally confirmed. Initially, there is irritability, throbbing, and then a pronounced pressing headache, which always captures only half of the head - the so-called hemicrania.

Angioedema

By its nature, it is closely associated with allergic pathology and is noted with increased release in the tissues of a large number of certain substances, mainly serotonin. In this case, swelling occurs in certain areas of the skin and mucous membranes, an increase in part of the organ in size.

An important point that distinguishes this type of local vascular crisis is the absence of characteristic itching and discoloration of the skin or mucous membranes.

Angiotrophoneurosis

Angiotrophoneurosis is not a pure type of vascular crisis. On the part of the vessels, this condition is characterized by a fairly rapid change in spasm and expansion in a certain part of the body. Usually the limbs are most affected, especially the fingers. Usually this is due to a violation of innervation.

The emerging processes gradually become permanent, which quickly leads to dystrophic changes in tissues, which makes it possible to consider such severe cases as separate diseases, including hereditary ones - Raynaud's disease, systemic scleroderma. From these positions, only the very initial stages can be attributed to angiotrophoneurotic local crises.

Treatment of vascular crises

Any type of vascular crisis, as an acute and sometimes serious condition, requires exceptionally qualified assistance. And to self-medicate (“a neighbor had the same thing and this helped her ...”) is unacceptable, ineffective, and sometimes simply dangerous to health.

When conditions arise that resemble a vascular crisis for the first time, which, by the way, can often be at work and in public places, you just need to immediately call an ambulance. The doctor will examine you and provide the necessary therapeutic measures, after which he will decide on your delivery to the hospital.

In a hospital or clinic, you must undergo a comprehensive examination to find out your existing diseases, as well as the causes leading to crises. This will help to choose the appropriate treatment and choose the necessary recommendations, both in terms of course or maintenance therapy, and for taking drugs in "emergency cases".

Therapist, Sovinskaya Elena Nikolaevna

The crisis has many manifestations and is accompanied by such violations:

The very word "crisis" indicates that an extreme, non-standard, critical situation occurred in the body, to which the body reacted in this way. A crisis is characterized by an excessive concentration in the blood of certain biological substances, such as:

At the same time, a sharp surge in the concentration of these substances is not the main reason for the onset of a crisis. The appearance and form of manifestation of the syndrome also depend on the individual characteristics of the organism of a single person. Both some external factor and the behavior of the autonomic nervous system (ANS) itself, which appears literally for no reason, can become provoking. In this regard, several types of failures have been identified.

Types of vegetative-vascular crises

There are four main types of crises related to the vegetative-vascular group:

• sympathetic-adrenal;
• vagoinsular;
• hyperventilation;
• vegetative-vestibular.

For any type, a sharp deterioration in the general condition of the patient is characteristic. However, some symptoms are also observed.

Symptoms by type

1. Sympathetic-adrenal crisis. Symptoms: severe headache; there is a pulsation in the head; in the region of the heart, a heartbeat is felt (unstable, intermittent); numbness of the limbs, trembling; blanching of the skin, dryness; chill-like tremor at elevated temperature; anxiety, feeling of fear.

The main symptoms of a sympathetic-adrenal crisis

This form of crisis, as suddenly appears, and suddenly passes. During a surge in the blood, the level of leukocytes and glucose increases. And then there is an increased diuresis with a low specific gravity. Asthenia develops.

1. Vagoinsular crisis. Symptoms: shortness of breath with a feeling of lack of air; feeling of sinking heart, intermittent heartbeat; dizziness; indigestion from rumbling and pain to urge; the pulse is weakened; increased moisture content of the skin; pronounced post-crisis asthenic condition.
2. hyperventilation crisis. The main manifestations are already clear from the name. They arise against the background of acute fear, anxiety, anxiety. Symptoms: shortness of breath, lack of air, "lump in the throat", a feeling of tightness in the chest; violation of the respiratory rhythm; rapid or deep breaths.

In addition to problems with respiratory function, a number of other sensations are observed: dizziness, clouding or loss of consciousness; a feeling of tingling or "running goosebumps" on the skin of the limbs, face; convulsive reduction of the foot or hand; uncontrolled contraction of the muscles of the limbs.

At the same time, typical signs from the side of the heart are also observed.

1. Vegetative-vestibular crisis. Symptoms: severe dizziness; nausea and vomiting; a sharp change in blood pressure (low). It can be triggered by a sharp turn of the head or a change in body position. In most cases, the duration of manifestation is short-term (several minutes). But sometimes it can take hours or even days.

Dystonic syndrome

Systematic crises (attacks) are clear evidence of the presence of vegetative-vascular dystonia. The development of the disease can be caused by various factors. For example, hereditary predisposition. Subject to dystonia are people who constantly experience nervousness, psycho-emotional stress, and who are in stressful situations. Pathogenic changes in the functions of the endocrine glands and age-related endocrine changes in the body.

Systematic crises are clear evidence of the presence of vegetative-vascular dystonia

The most susceptible to dystonia are older people, while women among patients are three times more. The disease is diagnosed in 80% of cases. Every third patient with such a diagnosis requires immediate therapeutic and neurological assistance.

First aid in a crisis situation

Note that many people are lost and do not know how to act with dystonia, even those who suffer themselves. For example, in an acute crisis, you need to quickly drip on a piece of refined sugar or mix heart drops with water. With a rapid heartbeat, you can take an anaprilin tablet. A couple of diazepam tablets under the tongue will help to cope with nervous excitement.

To cope with the problem of complicated breathing, it is best to use a regular paper bag. Inhale and exhale through it until the function is restored.

A frequent attack of dystonia is a short-term loss of consciousness, simply put, fainting. Before an attack, the patient turns pale, dizzy, dark in the eyes, short of breath, ringing in the ears, nausea. This condition is caused by a violation of vascular tone, outflow of blood from the brain, a decrease in blood pressure.

To prevent fainting, you need to urgently sit down or lean on something

The preventive actions of pre-syncope will be:

• urgently sit down or lean on something;
• loosen belts, ties and buttons on clothes so that nothing is squeezed;
• sit down so that the legs are higher than the head, for example, lower the upper body;
• ensure the flow of fresh air if an attack has overtaken the room;
• rubbing the feet and splashing the face with cold water.

Usually consciousness is restored in a few minutes. After bringing the person to his senses, give him warm sweet tea or coffee, you can take valerian.

But this is only first aid, that is, operational, which brings relief, but does not cure the disease.

Treatment

At the moment, nothing more effective than conservative methods for the treatment of dystonia has been invented. The patient in the future will have to completely reconsider his lifestyle.

1. Compliance with the daily routine with a sleep duration of at least 8-10 hours. For sleep, it is desirable to equip a comfortable bed of medium hardness. Sleep in a well ventilated area. During the day, reduce the time spent in front of the TV or computer, if the latter is not possible, be sure to arrange technical breaks. Daily outdoor walks. Alternating physical and mental stress.
2. Physical exercise. It can be morning exercises, jogging, hiking, cycling, aerobics, fitness equipment. As for training on simulators, you need to choose those where the head will not be below chest level. You should not choose gymnastic exercises with sharp turns of the head, body or large amplitude. Workouts don't have to be exhausting and difficult.
3. The revision of the diet provides for a decrease in the amount of salt, fatty meat, sweet and starchy foods. We lean on foods high in magnesium and potassium.
4. Physiotherapy.
5. water procedures.
6. Acupuncture.
7. Massotherapy.
8. Psychological correction.
9. Phyto- and drug therapy.

Do not self-medicate and prescribe medications for yourself. Manifestations of dystonia are individual for each case, therefore, the doctor prescribes medication individually. It takes into account: crisis symptoms, the age of the patient, the presence of other diseases, the individual predisposition of the body to the action of individual drugs.

Adhering to the prescription for treatment, you can nullify the crisis attacks on the body, or at least stabilize the condition to the level of rare manifestations. It depends only on the patient whether he can avoid dystonic crises in the future.

The information on the site is provided for informational purposes only and is not a guide to action. Do not self-medicate. Consult with your physician.

vestibular crisis

Vestibular crisis is accompanied by dizziness, tinnitus, vestibulo-vegetative reactions.

Causes of the vestibular crisis:

• atherosclerotic lesions of the vertebral and basilar arteries;
• arachnoiditis;
• labyrinthitis;
• some other diseases.

Symptoms of a vestibular crisis:

• transient dizziness;
• noise in ears;
• disorientation in space;
• extremely intense dizziness, causing sensations of movement of one's own body;
• nausea, vomiting;
• nystagmus;
• violation of muscle tone;
• discoordination of movements;
• the occurrence of a specific shaky gait.

At the time of the attack, the patient is forced to lie still with his eyes closed, since even the slightest movement causes dizziness, tinnitus, hearing loss, and vomiting.

Otoneurological tests are reliable diagnostic methods for vestibular crisis.

Treatment should be directed to the underlying disease, elimination of neurological and psychopathological syndromes - improve cerebral circulation and metabolic processes.

When treating a vestibular crisis, it is impossible to quickly reduce blood pressure.

Treatment of vestibular vertigo

JOURNAL OF NEUROLOGY AND PSYCHIATRY, 11, 2008 M.V. ZAMERGRAA, V.A. PARFENOV, O.A. MELNIKOV

Treatment of vestibular dizziness

M.V. ZAMERGRAD, V.A. PARFENOV, O.A. MELNIKOV

Clinic of nervous diseases. AND I. Kozhevnikov MMA them. THEM. Sechenov, ANO "Guta-Clinic", Moscow

Dizziness is one of the most common complaints among patients of different age groups. So, 5-10% of patients who go to general practitioners and 10-20% of patients to a neurologist complain of dizziness, especially elderly people suffer from it: in women over 70, dizziness is one of the most frequent complaints.

True, or vestibular vertigo is a sensation of imaginary rotation or movement (circling, falling or swinging) of surrounding objects or the patient himself in space. Vestibular vertigo is often accompanied by nausea, vomiting, imbalance and nystagmus, and in many cases it is aggravated (or appears) with changes in head position, rapid head movements. It should be noted that some people have a constitutional inferiority of the vestibular apparatus, which already in childhood manifests itself as a “motion sickness” - poor tolerance for swings, carousels and transport.

Causes and pathogenesis of vestibular vertigo

Vestibular vertigo can occur with damage to the peripheral (semicircular canals, vestibular nerve) or central (brain stem, cerebellum) departments of the vestibular analyzer.

Peripheral vestibular vertigo in most cases is due to benign positional vertigo, vestibular neuronitis or Meniere's syndrome, less often - compression of the vestibulocochlear nerve by a vessel (vestibular paroxysm), bilateral vestibulopathy or perilymphatic fistula. Peripheral vestibular vertigo is manifested by severe attacks and is accompanied by spontaneous nystagmus, a fall in the direction opposite to the direction of nystagmus, as well as nausea and vomiting.

Central vestibular vertigo is most commonly caused by vestibular migraine, less commonly by stroke in the brainstem or cerebellum, or multiple sclerosis involving the brainstem and cerebellum.

At least four mediators are involved in the conduction of a nerve impulse along the three-neuronal arc of the vestibulo-ocular reflex. Several more mediators are involved in the modulation of reflex arc neurons. Glutamate is considered the main excitatory mediator. Acetylcholine is an agonist of both central and peripheral (localized in the inner ear) M-cholinergic receptors. However, the receptors that presumably play a major role in the development of dizziness belong to the M2 subtype and are located in the region of the pons and medulla oblongata. GABA and glycine are inhibitory mediators involved in the transmission of a nerve impulse between the second vestibular neurons and the neurons of the oculomotor nuclei. Stimulation of both subtypes of GABA receptors - GABA-A and GABA-B - has a similar effect on the vestibular system. Animal experiments have shown that baclofen, a specific GABA-B receptor agonist, reduces the duration of the response of the vestibular system to stimuli. The significance of glycine receptors is not well understood.

An important mediator of the vestibular system is histamine. It is found in different parts of the vestibular system. Three subtypes of histamine receptors are known - H 1 , H 2 and H 3 . H 3 receptor agonists inhibit the release of histamine, dopamine and acetylcholine.

Treatment of vestibular vertigo is a rather difficult task. Often, a doctor prescribes “vasoactive” or “nootropic” drugs to a patient suffering from dizziness, without trying to understand the causes of dizziness. Meanwhile, vestibular vertigo can be caused by various diseases, the diagnosis and treatment of which should be the main efforts of the doctor.

At the same time, with the development of vestibular vertigo, symptomatic treatment aimed at stopping an acute attack of vertigo comes to the fore, but in the future, rehabilitation of the patient and restoration of compensation for vestibular function becomes relevant (hereinafter we use the designation "vestibular rehabilitation").

Relief of an acute attack of vestibular vertigo

Relief of an attack of dizziness is primarily to ensure maximum rest for the patient, since vestibular dizziness and often accompanying vegetative reactions in the form of nausea and vomiting are aggravated by moving and turning the head. Drug treatment involves the use of vestibular suppressors and antiemetics.

Vestibular suppressors include three main groups of drugs: anticholinergics, antihistamines, and benzodiazepines.

Anticholinergic drugs inhibit the activity of the central vestibular structures. Use drugs containing scopolamine or platifillin. Side effects of these drugs are mainly due to the blockade of M-cholinergic receptors and are manifested by dry mouth, drowsiness and accommodation disorder. In addition, amnesia and hallucinations are possible. With great care, scopolamine is prescribed to the elderly because of the risk of developing psychosis or acute urinary retention.

It has now been proven that anticholinergics do not reduce vestibular vertigo, but can only prevent its development, for example, in Meniere's disease. Because of their ability to delay vestibular compensation or to cause a breakdown of compensation once it has already occurred, anticholinergics are increasingly being used in peripheral vestibular disorders.

With vestibular vertigo, only those H 1 blockers that penetrate the blood-brain barrier are effective. These drugs include dimenhydrinate (dramina, mg 2-3 times a day), diphenhydramine (diphenhydramine, mg orally 3-4 times a day or mg intramuscularly), meclozine (bonin, mg/day in the form of chewable tablets). All of these drugs also have anticholinergic properties and cause corresponding side effects.

Benzodiazepines enhance the inhibitory effects of GABA on the vestibular system, which explains their effect in vertigo. Benzodiazepines, even in small doses, significantly reduce dizziness and associated nausea and vomiting. The risk of drug dependence, side effects (drowsiness, increased risk of falls, memory loss), and slowing of vestibular compensation limit their use in vestibular disorders. Lorazepam (Lorafen) is used, which at low doses (eg 0.5 mg 2 times a day) rarely causes drug dependence and can be used sublingually (at a dose of 1 mg) for an acute attack of dizziness. Diazepam (Relanium) at a dose of 2 mg 2 times a day can also effectively reduce vestibular vertigo. Clonazepam (antelepsin, rivotril) has been less studied as a vestibular suppressant but appears to be as effective as lorazepam and diazepam. Usually it is prescribed at a dose of 0.5 mg 2 times a day. Long-acting benzodiazepines, such as phenazepam, are not effective for vertigo.

In addition to vestibular suppressants, antiemetics are widely used in acute attacks of vestibular vertigo. Among them, phenothiazines are used, in particular prochlorperazine (meterazine, 5-10 mg 3-4 times a day) and promethazine (pipolfen, 12.5-25 mg every 4 hours; can be administered orally, intramuscularly, intravenously and rectally ). These drugs have a large number of side effects, in particular, they can cause muscular dystonia, and therefore are not used as first choice drugs. Metoclopramide (cerucal, 10 mg IM) and doperidone (motilium, mg 3-4 times a day, orally) - blockers of peripheral D 2 receptors - normalize the motility of the gastrointestinal tract and thus also have an antiemetic effect. Ondansetron (Zofran, 4-8 mg orally), a serotonin 5-HT3 receptor blocker, also reduces vomiting in vestibular disorders.

The duration of use of vestibular suppressants and antiemetics is limited by their ability to delay vestibular compensation. In general, it is not recommended to use these drugs for more than 2-3 days.

The purpose of vestibular rehabilitation is to accelerate the compensation of the function of the vestibular system and create conditions for the fastest adaptation to its damage. Vestibular compensation is a complex process that requires restructuring of numerous vestibulo-ocular and vestibulospinal connections. Among the relevant activities, a large place is occupied by vestibular gymnastics, which includes various exercises for eye and head movements, as well as gait training.

The first complex of vestibular gymnastics, intended for patients with unilateral damage to the vestibular apparatus, was developed by T. Cawthorne and F. Cooksey in the 40s of the last century. Many exercises from this complex are still used today, although now preference is given to individually selected rehabilitation complexes, taking into account the peculiarities of damage to the vestibular system of a particular patient.

Vestibular rehabilitation is indicated for stable, i.e. non-progressive damage to the central and peripheral parts of the vestibular system. Its effectiveness is lower in central vestibular disorders and Meniere's disease. Nevertheless, even with these diseases, vestibular gymnastics remains indicated, since it allows the patient to partially adapt to the existing disorders.

Vestibular exercises begin immediately after the relief of an episode of acute dizziness. The sooner vestibular gymnastics is started, the faster the patient's working capacity is restored.

Vestibular gymnastics is based on exercises in which movements of the eyes, head and torso lead to sensory mismatch. Performing them at first can be associated with significant discomfort. The tactics of vestibular rehabilitation and the nature of the exercises depend on the stage of the disease. The table below shows an exemplary vestibular gymnastics program for vestibular neuronitis.

The effectiveness of vestibular gymnastics can be improved with the help of various simulators, for example, a stabilographic or posturographic platform that works according to the biofeedback method.

Clinical studies have shown that improvement in vestibular function and stability as a result of vestibular rehabilitation is observed in 50-80% of patients. Moreover, in 1/3 of patients, compensation is complete. The effectiveness of treatment depends on age, the timing of the start of rehabilitation from the moment the disease develops, the emotional state of the patient, the experience of the doctor conducting vestibular exercises, and the characteristics of the disease. Thus, age-related changes in the visual, somatosensory, and vestibular systems can slow down vestibular compensation. Anxiety and depression also lengthen the process of adaptation to developed vestibular disorders. Compensation for damage to the peripheral vestibular system occurs faster than with central vestibulopathies, and unilateral peripheral vestibular disorders are compensated faster than bilateral ones.

The possibilities of drug therapy to accelerate vestibular compensation are currently limited. Nevertheless, studies of various drugs supposedly stimulating vestibular compensation are ongoing. One such drug is betahistine hydrochloride. By blocking histamine H 3 receptors of the central nervous system, the drug increases the release of the neurotransmitter from the nerve endings of the presynaptic membrane, exerting an inhibitory effect on the vestibular nuclei of the brain stem. Betaserc is applied in doses per day for one or several months.

Another drug that improves the speed and completeness of vestibular compensation is piracetam (nootropil). Nootropil, being a cyclic derivative of gamma-aminobutyric acid (GABA), has a number of physiological effects that can be explained, at least in part, by the restoration of the normal function of cell membranes. At the neuronal level, piracetam modulates neurotransmission in the range of neurotransmitter systems (including cholinergic and glutamatergic), has neuroprotective and anticonvulsant properties, and improves neuroplasticity. At the vascular level, piracetam increases the plasticity of erythrocytes, reducing their adhesion to the vascular endothelium, inhibits platelet aggregation and improves microcirculation in general. It should be noted that with such a wide range of pharmacological effects, the drug has neither a sedative nor a psychostimulant effect.

Vestibular rehabilitation with vestibular neuronitis (according to T. Brandt with changes)

Incomplete suppression of spontaneous nystagmus during gaze fixation

Fixation of gaze straight, at an angle of 10°, 20° and 40° vertically and horizontally; reading.

Smooth following movements, for example, following a finger or hammer moving at a speed of 20-40 ° / s, 20-60 ° / s.

Head movements when fixing the gaze on a stationary object located at a distance of 1 m (0.5-2 Hz; 20-30 ° horizontally and vertically).

Stand and walk with eyes open and closed (with support)

The appearance of nystagmus when the eyes are turned towards the fast phase of nystagmus and in Frenzel glasses

2. Dynamic balance exercise: eye and head movements (as in the previous section) while standing without support

Small spontaneous nystagmus in Frenzel glasses

The variety of physiological effects explains the use of nootropil for a variety of clinical indications, including various forms of vertigo. In an animal experiment, it has been shown that the drug suppresses nystagmus caused by electrical stimulation of the lateral geniculate body. In addition, studies involving healthy subjects have found that nootropil can reduce the duration of nystagmus caused by rotational trial. The effectiveness of the drug is partly due, apparently, to the stimulation of cortical control over the activity of the vestibular system. By increasing the threshold of sensitivity to vestibular stimuli, nootropil reduces dizziness. It is believed that the acceleration of vestibular compensation under its action is also due to the effect of the drug on the vestibular and oculomotor nuclei of the brain stem. Nootropil directly improves the functions of the inner ear. Due to the fact that central vestibular adaptation and compensation probably depend on good transmission of nerve impulses, the modulating effect of the drug on the cholinergic, dopaminergic, noradrenergic and glutamatergic systems can accelerate this process. An important property of nootropil is its effect on neuroplasticity. Neuroplasticity is of great importance for adaptation as it is important for neural rewiring. The effect on neuroplasticity is another proposed reason for the acceleration of vestibular compensation under the action of this drug.

The acceleration of vestibular compensation under the action of nootropil in dizziness of peripheral, central or mixed origin is confirmed by the results of several studies. The use of nootropil significantly and quickly (2-6 weeks) led to a decrease in dizziness and headache, leveling of vestibular manifestations with and without restoration of the function of the vestibular apparatus, as well as a decrease in the severity of instability and symptoms between attacks of dizziness. The drug significantly improved the quality of life of patients with persistent dizziness. Nootropil is primarily recommended for dizziness caused by damage to the central vestibular structures, however, given the non-specific mechanism of action of the drug, it can be effective in all types of dizziness. Nootropil is prescribed orally at a dose of mg / day, the duration of treatment is from one to several months.

Differentiated treatment for various diseases manifested by vestibular vertigo

Benign positional paroxysmal vertigo (BPPV)

The basis of the treatment of BPPV are special exercises and therapeutic techniques that have been actively developed for 20 years. As a vestibular gymnastics, which the patient can perform himself, the Brandt-Daroff technique is used. In the morning, after waking up, the patient should sit in the middle of the bed with their legs hanging down. Then you should lie on your right or left side with your head turned 45 ° up and stay in this position for 30 seconds or, if dizziness occurs, until it stops. Then the patient returns to the starting position (sitting on the bed) and stays in it for 30 s. After that, the patient lies on the opposite side with the head turned 45 ° up and is in this position for 30 seconds or, if dizziness occurs, until it stops. Then he returns to his original position (sitting on the bed). The patient should repeat this exercise 5 times. If dizziness does not occur during morning exercises, then it is advisable to repeat the exercises only the next morning. If dizziness occurs at least once in any position, then it is necessary to repeat the exercises two more times: in the afternoon and in the evening. The duration of vestibular gymnastics is determined individually: the exercises continue to be done until dizziness disappears and another 2-3 days after it stops. The effectiveness of this technique for stopping BPPV is about 60%.

Therapeutic exercises that are performed by a doctor are more effective. Their efficiency reaches 95%.

An example of such exercises is the Epley technique, developed for the treatment of BPPV caused by pathology of the posterior semicircular canal. In this case, the exercises are performed by the doctor along a clear trajectory with a relatively slow transition from one position to another. The initial position of the patient is sitting on the couch with the head turned towards the affected labyrinth. Then the doctor puts the patient on his back with his head thrown back by 45 ° and turns the fixed head in the opposite direction. After that, the patient is laid on his side, and his head turns with a healthy ear down. Then the patient sits down, his head bends and turns towards the affected labyrinth. The patient then returns to the starting position. During the session, 2-4 exercises are usually performed, which is often enough to completely stop BPPV.

In 1-2% of patients suffering from BPPV, therapeutic exercises are ineffective and adaptation develops extremely slowly. In such cases, resort to surgical tamponade of the affected semicircular canal with bone chips or selective neuroectomy of the vestibular nerve. Selective neurectomy of the vestibular nerve is used much more frequently and is rarely accompanied by complications.

To date, Meniere's disease remains incurable. Therefore, we are talking about symptomatic treatment, the purpose of which is to reduce the frequency and severity of vertigo attacks, as well as to prevent hearing loss. The effectiveness of therapy is evaluated over a long period of time: the number of dizziness attacks is compared for at least two periods of 6 months. There are two directions of drug treatment: relief of an attack and prevention of recurrence of the disease.

The relief of an attack of dizziness is carried out according to the general principles described earlier. To prevent recurrence of the disease, a diet with salt restriction to 1-1.5 g per day, low in carbohydrates is recommended. If the diet is ineffective, diuretics are prescribed (acetazolamide or hydrochlorothiazide in combination with triamterene).

Among the drugs that improve the blood supply to the inner ear, betahistine (betaserc) in dosemg per day is most commonly used, the effectiveness of which has been shown both in a placebo-controlled study and in comparison with other drugs.

With the ineffectiveness of conservative treatment and a high frequency of dizziness attacks, surgical methods of treatment are used. The most common methods are endolymphatic sac decompression surgery and intratympanic administration of gentamicin.

In the acute period of the disease, drugs are used that reduce dizziness and associated autonomic disorders (see above). To speed up the recovery of vestibular function, vestibular gymnastics is recommended, which includes exercises in which eye, head, and torso movements lead to sensory mismatch. These exercises stimulate central vestibular compensation and speed up recovery.

Vestibular vertigo in cerebrovascular disease

Vestibular vertigo may be a symptom of transient ischemic attack, ischemic or hemorrhagic stroke in the brainstem and cerebellum. In most cases, it is combined with other symptoms of damage to these parts of the brain (for example, diplopia, dysphagia, dysphonia, hemiparesis, hemihypesthesia, or cerebellar ataxia). Much less often (according to our data, in 4.4% of cases), vestibular vertigo is the only manifestation of cerebrovascular disease.

The management of a stroke patient with dizziness is carried out according to medical tactics for ischemic stroke or cerebral hemorrhage. In the first 3-6 hours of ischemic stroke, thrombolysis can be used, with hemorrhage in the cerebellum, surgery is possible. With severe dizziness, nausea and vomiting, vestibular suppressants can be used for a short time (up to several days). Of great importance is the management of the patient in a specialized department (stroke department), in which somatic complications are most effectively prevented, early rehabilitation of the patient is carried out.

Treatment of vestibular migraine, as well as treatment of ordinary migraine, consists of three areas: elimination of migraine-provoking factors, relief of an attack, and preventive therapy. Elimination of migraine-provoking factors: stress, hypoglycemia, certain foods (aged cheeses, chocolate, red wine, whiskey, port wine) and nutritional supplements (monosodium glutamate, aspartame), smoking, use of oral contraceptives - can reduce the frequency of vestibular migraine attacks.

For the relief of vestibular migraine, anti-migraine drugs and vestibular suppressants are used. Dimenhydrinate (dramin), benzodiazepine tranquilizers (diazepam), and phenothiazines (thiethylperazine) are used as vestibular suppressants; when vomiting, the parenteral route of administration is used (diazepam IM, metoclopramide IM, thiethylperazine IM or rectally in suppositories). Anti-inflammatory drugs (ibuprofen, diclofenac), acetylsalicylic acid, and paracetamol may be effective. The effectiveness of ergotamine and triptan preparations was noted. The effectiveness of anti-migraine drugs for the relief of vestibular migraine corresponds to their effectiveness in ordinary migraine attacks. Triptans are discouraged by some authors because they increase the risk of ischemic stroke in basilar migraine.

Preventive therapy is indicated for frequent (2 or more per month) and severe attacks of vestibular migraine. As drugs of choice, beta-blockers (propranolol or metoprolol), tricyclic antidepressants (nortriptyline or amitriptyline) and calcium antagonists (verapamil) are used. In addition, valproate (mg/day) and lamotrigine (mg/day) are used. The starting daily dose of verapamil is mg/day; the maximum daily dose should not exceed 480 mg. The starting dose of nortriptyline is 10 mg/day, with ineffectiveness, the dose is increased by 100 mg/day, while the maximum daily dose should not exceed 100 mg. The starting dose of propranolol is 40 mg / day, if this dose is ineffective and the drug is well tolerated, the daily dose is gradually (weekly) increased by 20 mg, but so that it does not exceed halamg.

Comprehensive preventive treatment, including diet and the use of small doses of tricyclic antidepressants and beta-blockers, is effective in more than half of patients. If the treatment is effective, the drugs continue to be taken for a year, and then gradually (within 2 or 3 months) are canceled.

Thus, at present, non-specific treatment of vestibular vertigo is divided into two stages: in the acute period, drug therapy is mainly used, the purpose of which is to reduce dizziness and its accompanying autonomic disorders, primarily in the form of nausea and vomiting. Immediately after the end of the acute period, they proceed to the second stage of treatment, the main purpose of which is vestibular compensation and the speedy restoration of the patient's working capacity. To date, it is generally recognized that the basis of treatment at this stage should be vestibular rehabilitation. Properly and timely selected vestibular gymnastics improves balance and gait, prevents falls, reduces instability, subjective feeling of dizziness and increases the daily activity of the patient. Of great importance is the differentiated treatment of vestibular vertigo, based on the timely diagnosis of the underlying disease.

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