Dizziness pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2] Norina Usman, M.B.B.S[3]
Overview
The pathophysiology of dizziness depends on the etiological subtype including orthostatic hypotension, benign paroxysmal positional vertigo, Meniere's disease, Parkinson's disease, hyperventilation syndrome, peripheral neuropathy, and vestibular migraine.
Pathophysiology
The pathophysiology of dizziness depends on the etiological subtype, and area of pathology involved[1][2][3][4][5].
| Cause | Pathophysiology | Category of dizziness |
|---|---|---|
| Orthostatic hypotension | It is a drop in blood pressure on changing the position or can be due to the side effect of the medicine | Presyncope |
| Benign paroxysmal positional vertigo | The semicircular canal contains loose otolith, which gives a false sense of motion. | Vertigo |
| Meniere's disease | Excessive endolymphatic fluid in the inner ear | Vertigo |
| Hyperventilation syndrome | Hyperventilation leads to respiratory alkalosis | Lightheadedness |
| Peripheral neuropathy | Decrease tactile sensation may cause patients to lack the feeling of feet to be touched to the ground leading to falls and imbalance. | Disequilibrium |
| Parkinson disease | Gait dysfunction cause falls and imbalance | Disequilibrium |
| Vestibular migraine | Uncertain | Vertigo |
The pathophysiology of dizziness can be explained according to one of its classification systems based on central and peripheral, although there is often overlap between the two.[6] -Peripheral
-Vestibular dysfunction which involves vestibular neuritis/neuronitis can occur as a single attack or multiple attacks. When there is concurrent hearing loss, it is termed at neurolabyrinthitis. The hair cell bodies are said to be involved that help in transducing movement. -Bilateral vestibular hypofunction (partial or complete): usually by toxic (gentamicin) or immune mechanisms. -Autoimmune: rapidly progressive and bilateral. Like any other autoimmune disease, there is a female preponderance in the reproductive age group. -Systemic or central vestibular dysfunction: involves the vestibular nuclei. -Meniere's disease which is the tetrad of vertigo, tinnitus, sensorineural hearing loss and aural fullness. The exact etiology is unknown although viral causes have been implicated. The symptoms arise because of endolymphatic pressure change. -BPPV: The posterior semicircular canal is the most commonly involved space. The most likely etiology is dislodgment of an otoconia. -Perilymphatic fistula: Fistula is an abnormal communication between two structures; in this case between the membranous labyrinth and middle ear. Can be due to causes like barotrauma (implosive) or increased intracranial pressure (explosive). Acquired fistulas may result from chronic ear surgery.
References
- ↑ Hanley K, O'Dowd T, Considine N (2001). "A systematic review of vertigo in primary care". Br J Gen Pract. 51 (469): 666–71. PMC 1314080. PMID 11510399.
- ↑ Ebersbach G, Sojer M, Valldeoriola F, Wissel J, Müller J, Tolosa E; et al. (1999). "Comparative analysis of gait in Parkinson's disease, cerebellar ataxia and subcortical arteriosclerotic encephalopathy". Brain. 122 ( Pt 7): 1349–55. doi:10.1093/brain/122.7.1349. PMID 10388800.
- ↑ Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA; et al. (1992). "Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care". Ann Intern Med. 117 (11): 898–904. doi:10.7326/0003-4819-117-11-898. PMID 1443950.
- ↑ Hoffman RM, Einstadter D, Kroenke K (1999). "Evaluating dizziness". Am J Med. 107 (5): 468–78. doi:10.1016/s0002-9343(99)00260-0. PMID 10569302.
- ↑ Kentala E, Rauch SD (2003). "A practical assessment algorithm for diagnosis of dizziness". Otolaryngol Head Neck Surg. 128 (1): 54–9. doi:10.1067/mhn.2003.47. PMID 12574760.
- ↑ "Dizziness".