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Causes of Vertigo

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Vertigo, which means dizziness usually accompanied with nausea, is a multifactor symptom that can occur with various ear disorders.

Normal equilibrium depends on the interrelationship of sensations coming from many different organs: from the eyes, muscles, tendons, skin receptors and also from the balance mechanism of the labyrinths of the ear. If these signals are at variance with one another (as interpreted by the higher centres of the brain), and there is a consequent interference with coordination, then vertigo may result.

There are many causes, and there are several conditions in which this symptom is prominent.

Meniere’s Disease

This has already been considered, and is probably the most dramatic disorder involving balance problems.

Benign Postural Vertigo

This can take place when the head is in a particular position. There is usually no obvious cause, or conversely it may follow on from some form of head injury. Symptoms often abate with or without treatment within three to six months.

Toxicity

Some medicinal preparations arc well-known for their ability to destroy or interfere with vestibular function. Streptomycin, medications used for epilepsy, mental depression and hypertension, come into this category. The symptoms may not be clear-cut. If possible, altering medication may bring relief.

Epidemic Vertigo

This strange disorder may occur in young people who have had a simple viral infection. Often many persons with a similar infection about the same time will report sensations of vertigo and vomiting. The cause is unknown but it is probably a toxic effect from the invading germ on the vestibular mechanism. Prochlorperazine may assist, although the condition is probably self-limiting.

Psychogenic Vertigo

Some neurotic patients will describe their vertigo symptoms in striking terms. The level of authenticity is hard to determine, as it is more likely to be one symptom in a maze.

Ischaemia Vertigo

Some patients suffer from vertigo as part of a definite pathological vascular deficiency of the blood supply to the brain. It is referred to as vertebrobasilar ischemia and is really one symptom in a series of others. It is more probable in the person, and treatment is usually satisfactory.

Vertigo

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What is Vertigo?

Vertigo is a fairly common symptom, and means a subjective sensation of rotary movement, either to the person or of the environment. Often there is inability of the upright body to remain so, and there may be a falling to one side. Sometimes the patient may fall to the floor. but the subjective sensation is that the floor has come up and hit the patient. Disorientation occurs.

Vertigo comes from a word meaning a turning, and the sense of rotation that takes place is an apt description of symptoms. The so-called eighth cranial nerve (the auditory nerve) has two parts. One, the auditory component, is concerned with the appreciation of sound. The other, called the vestibular part, supplies the balance mechanism located within the inner part of the ear.

Often infections of the labyrinths (commonly in association with an upper respiratory tract viral infection – often called URTI) may adversely affect the vestibular nerve and mechanism. So an acute labyrinthitis may occur.

Vertigo Symptoms

Intense vertigo, usually with a marked tinnitus (ringing sensation in the ears), a staggering gait, and possibly irregular eye movements may occur.

Vertigo Treatment

Bed rest for a few days is essential, for it may be impossible to carry on normal activities in the upright position. It is worth treating any intercurrent infection (such as an URTI). Antibiotics are usually useless, for this is often viral in nature, and antibiotics will not kill viruses.

Treatment is entirely symptomatic. A darkened room with peace and quiet is often preferable. Sedation or the use of tranquillisers may he ordered by the doctor. Prochlorperazine, either in tablet form (Stemetil) or injection, may assist in alleviating the dizziness. But such treatment must be ordered by the physician. As the URTI or intercurrent infection subsides, the symptoms of the labyrinthitis usually decline and phase out with no aftermath. Any persisting form, of course, needs adequate medical investigation.

Blood Cancers

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There is a group of diseases considered to be the cancers of the blood system. They are generally referred to as leukaemias and lymphomas, or malignant diseases of the lymphoreticular system.

White blood cells are produced in bone marrow and in lymphoid tissue, which means the spleen and the lymphatic glands located in various parts of the body. This is collectively referred to as lymphoreticular tissue.

Just as cancers can occur in any system, the regions producing blood cells are not immune. For a variety of reasons (many now clearly understood. others as yet unknown), these cell-production sites may suddenly begin to produce cells at a rate far in excess of normal. It is due to a disorder of the basic structure of the cell-producing material. As increased numbers of cells are poured into the blood system, more and more immature forms find their way into the circulation.

Under normal conditions blood cells reach maturity and, only when they are in a finished fully developed state, capable of carrying out their appointed duties.

Blood cells go through a distinct routine of development, and the very early cell is called a blast cell. As disease of these systems progresses, more immature blast cells appear in the circulating blood, and this, plus the great augmentation in gross numbers, often leads to the diagnosis of the disease.

There is an extensive classification of these diseases. Once they were considered to be individual disorders. But with greater knowledge and more work being carried out in research centers, it is now quite evident that they are all closely interrelated.

There are two main types:

(1) Malignant disease affecting the bone marrow.

This interferes with production of the cells normally produced here. It may be an acute form, giving rise to the disease known as acute leukaemia when the white cells are affected, or an erythraemia when the red-cell system is affected.

It may be a slower type of disorder, producing chronic forms of disease, such as chronic leukaemia, affecting the white cells, or polycythaemia vera that affects red-cell production, or essential thrombocythaemia (producing excessive platelets).

(2) Malignant disease affecting the lymphoid tissues.

This may produce the well-known disorder called Hodgkin’s disease, as well as many other, less frequently occurring, subclassifications.

In comparison to simple iron-deficiency anaemia, these diseases are rare, and in comparison to cancers in general, the proportion of mortalities attributed to them is also small. In Australia, no more than 1200 deaths annually are due to leukaemia, a small fraction of the 30,000 annual deaths due to cancers in general.

Deficiencies

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Recent study in the past few years has shown deficiencies are all far from simple. Several additional items, referred to as blood Factors, are also present, and these are necessary to complete the chain of reaction. To date, 13 Factors have been identified, called Factor I, Factor II, Factor III and so on. In this system, fibrinogen is also called Factor I, prothrombin is Factor II, tissue extracts Factor VII and so on.

Each Factor plays a key part, and if one is missing, then serious defects may occur.

From a practical point of view, in the bleeding diseases named haemophilia, Factor VIII is missing; in Christmas disease, Factor IX is absent. This means that the patient is subject to serious deficiencies in the normal clotting mechanism. In part this may be overcome at times of particular need (such as when surgery is necessary, or teeth must be extracted) by giving plasma with a high concentration of the missing Factor.

When a clot is formed, it will remain there for a given period of time to enable the broken vessel to heal. When healing is complete, the clot is no longer necessary. So a reverse process then sets in.

This is termed fibrinolysis (a lysis or break down of’ the insoluble fibrin clot). It is brought about by activators converting plasminogen (widely dispersed through the body) to plasmin, and this being a “proteolytic enzyme,” works on the clot to gradually break it down.

The platelets, which form part of the cellular component of the blood, are intimately involved with the clotting process. If’ a blood vessel is broken, they immediately mobilize and quickly form a soft clot at the site of injury, and effectively plug it up. But soon after this occurs, the fibrin-producing elements arc under way, and this reinforces more permanently the temporary platelet plug.

But it is a vital first-aid measure and plays an effective role in checking immediately the loss of blood.


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