DIFFERENTIAL DIAGNOSIS OF RECURRENT VESTIBULAR DISORDERS IN PATIENTS WITH CHRONIC CEREBRAL CIRCULATORY INSUFFICIENCY

Аннотация

Dizziness is one of the most frequent reasons for seeking medical help among patients of different ages and is encountered in the practice of a doctor of any specialty. About 5 to 30% of people in the population suffer from dizziness. In outpatient practice of domestic health care, dizziness is the main reason for seeking medical help in at least 20% of cases. Women apply 2 times more often than men. The prevalence of this symptom increases with age. Key words: differential diagnosis, vestibular disorders, vertigo, chronic cerebral circulatory insufficiency. Introduction. Chronic cerebrovascular accidents are very common among the population, being one of the causes of disability and deterioration of the quality of life of patients, and remain an extremely important scientific and practical problem. Chronic cerebrovascular accidents, with which multifocal or diffuse ischemic brain damage develops, is manifested by a complex of neurological and neuropsychological diseases and has a tendency to gradually increase .The development of the cerebral vascular process produces persistent neurological manifestations, which include vestibuloatactic syndrome, manifested by dizziness, excitement and instability during walking . Dizziness is one of the most common complaints among patients and is the second most common symptom after headaches, affecting quality of life, causing falls and injuries. A fall due to dizziness once or several times a year is observed in 30% of people over 65 years of age.The prevalence of vestibuloatactic syndrome, the variety of its manifestations, the difficulties of differential diagnosis, long-term, sometimes permanent disability determine the medical and social significance, new diagnostic methods and the feasibility of further study and search for correction of these diseases. The subjective nature of dizziness and the frequent absence of objective signs of damage to the vestibular system make it difficult to identify the causes of this pathology [1]. There are many diseases in which dizziness is mentioned as one of the main or secondary symptoms. At the same time, the relationship between the underlying disease and dizziness is often assumed. In this regard, a syndromological diagnosis of peripheral or central vestibular vertigo, vestibular vertigo, is used in medicine, which indicates only 194 CURRENT APPROACHES AND NEW RESEARCH IN MODERN SCIENCES International scientific-online conference the assumed anatomical level of the lesion and does not have a nosological affiliation [2]. The practice of using a syndromic diagnosis can be justified only at the initial stage of the differential diagnosis of vertigo, but cannot be considered correct when formulating a final diagnosis. Nevertheless, the syndromic diagnosis of the so-called "peripheral" and "central" causes of dizziness determines the further sequence and scope of examination of patients, as well as the tactics of their treatment, which is important. In this regard, the development of an algorithm for differential diagnosis of vertigo that is available for use in primary care is very relevant [3]. In Russian medicine, dizziness is traditionally and primarily associated with vascular pathology of the brain, which contributes to the formation of ideas about the priority role of chronic cerebral circulatory insufficiency in the vertebral-basilar artery basin in the development of this syndrome. Overestimation of the role of degenerative changes in the cervical spine and the results of ultrasound examination of the vertebral arteries (PA) contributes to the overdiagnosis of this cause of dizziness [4]. At the same time, in the last decade there has been a significant transformation of ideas about the origin of most vestibular disorders. According to a number of clinical and epidemiological studies, the most common causes of dizziness are the so-called peripheral vestibulopathies resulting from pathology of the inner ear or nerve [5]. In about 30-40% of cases, the origin of vertigo remains unclear [23; 25; 27; 70; 101; 108]. This is largely due to the lack of clear regulated standards for the diagnosis of vestibular disorders and an insufficient number of clinical studies [6]. Conclusions: thus, the development of an algorithm for the differential diagnosis of peripheral and central vestibular disorders in patients diagnosed with chronic cerebral ischemia seems to be a very relevant problem of neurology and the basis for this study.