What causes peripheral vertigo? What other symptoms may accompany peripheral vertigo? How is peripheral vertigo treated? What causes central vertigo? What other symptoms could occur with central vertigo? How is central vertigo treated?

The Epidemiology of True Vertigo Patients in the Emergency Department

Vertigo is a common condition that can have various underlying causes, ranging from inner ear disorders to neurological issues. Understanding the epidemiology of true vertigo patients presenting to the emergency department is essential for healthcare professionals to provide appropriate and efficient care. This article delves into the two main types of vertigo – peripheral and central – exploring their causes, symptoms, and treatment options.

Peripheral Vertigo

Peripheral vertigo is the most common type of vertigo, typically caused by a problem in the inner ear. The most common causes of peripheral vertigo include:

1. Benign paroxysmal positional vertigo (BPPV): A condition where small crystals in the inner ear become dislodged, leading to a sudden onset of dizziness.
2. Vestibular neuronitis: A viral infection of the inner ear that causes severe dizziness.
3. Meniere’s disease: A condition that combines symptoms of dizziness with occasional hearing loss, often triggered by stress, salt intake, or consumption of caffeine and alcohol.

Symptoms associated with peripheral vertigo may include nausea, vomiting, sweating, and ear-related issues such as pain or a feeling of fullness. The vertigo often starts and stops abruptly, and the patient may experience involuntary eye movements that disappear when focusing on a fixed point.

Treatment for peripheral vertigo typically involves managing the underlying condition. For BPPV, the Epley maneuver, a series of head movements performed in the doctor’s office, can help reposition the crystals in the inner ear. Anti-inflammatory medications may be used to alleviate symptoms in conditions like vestibular neuronitis or Meniere’s disease. Lifestyle changes, such as reducing salt, caffeine, and alcohol intake, may also be recommended for Meniere’s disease.

Central Vertigo

Central vertigo is caused by a disease or injury affecting the brain, rather than the inner ear. Potential causes of central vertigo include:

• Head injuries
• Illnesses or infections
• Multiple sclerosis
• Migraines
• Brain tumors
• Strokes and transient ischemic attacks

Unlike peripheral vertigo, episodes of central vertigo often come without warning and may last for extended periods. The vertigo is generally more intense, and the patient may be unable to stand or walk without assistance. Involuntary eye movements may also occur.

The treatment for central vertigo depends on the underlying cause. Addressing the underlying brain-related condition, such as treating a tumor or managing a neurological disorder, is the primary approach. Medication may be prescribed to alleviate symptoms, and physical therapy may be recommended to help the patient regain balance and mobility.

Epidemiological Considerations

Researchers have found that true vertigo patients, those experiencing the sensation of the world spinning around them, account for a significant portion of emergency department visits. Understanding the epidemiology of these patients can help healthcare providers improve the quality of care and optimize resource allocation.

Studies have shown that peripheral vertigo is more common than central vertigo, with BPPV being the most prevalent cause. Factors such as age, gender, and underlying medical conditions can also influence the prevalence and presentation of vertigo in the emergency department setting.

Diagnostic Considerations

Accurately distinguishing between peripheral and central vertigo is crucial for providing appropriate treatment. Healthcare providers may utilize various diagnostic tools, such as medical history, physical examination, and specialized tests (e.g., oculomotor evaluation, imaging studies), to differentiate the underlying cause of the patient’s vertigo.

Prompt and accurate diagnosis is essential, as the management strategies for peripheral and central vertigo differ significantly. Misdiagnosing the type of vertigo can lead to suboptimal treatment and potentially adverse outcomes for the patient.

Implications for Healthcare Professionals

The epidemiological data on true vertigo patients in the emergency department highlights the importance of healthcare professionals being well-versed in the assessment and management of these conditions. Continuous education, the implementation of clinical guidelines, and the development of multidisciplinary care teams can all contribute to improved patient outcomes.

By understanding the common causes, symptoms, and treatment options for both peripheral and central vertigo, healthcare providers can optimize the care delivered to patients presenting with this debilitating condition. This knowledge can lead to more efficient triage, accurate diagnosis, and effective management strategies, ultimately enhancing the quality of care and patient satisfaction.

Peripheral, Central, BPPV, and More

Written by Paula Ford-Martin

• What Causes Peripheral Vertigo?
• What Other Symptoms May I Have With Peripheral Vertigo?
• How Is Peripheral Vertigo Treated?
• What Causes Central Vertigo?
• What Other Symptoms Could I Have From Central Vertigo?
• How Is Central Vertigo Treated?
• More

If you’ve been on your share of amusement park rides, you probably know what vertigo is like — the feeling that the world is spinning around you. But if you feel dizzy and didn’t just step off a roller coaster, check with your doctor to see if you’ve got one of the two most common forms of vertigo: central and peripheral.

There are drugs and other treatments for both types. Finding out which one you’ve got — and what’s causing it — can help you and your doctor decide how to manage it.

Keep in mind that vertigo is a symptom of a medical condition, not a disease by itself. Your doctor will try to figure out what’s behind it.

If your doctor tells you that you have peripheral vertigo, you’ve got plenty of company. It’s the most common type of vertigo. Most cases are caused by a problem in the inner ear, which controls your balance.

The most common causes of the inner ear trouble that leads to peripheral vertigo are:

• Benign paroxysmal positional vertigo (BPPV)
• Vestibular neuronitis
• Meniere’s disease

BPPV is a condition that causes small crystals to get loose and start to float in the fluid of your inner ear. The movement of the crystals and the fluid leads you to feel dizzy. Sometimes an ear injury can lead to BPPV.

Vestibular neuronitis causes severe dizziness that comes on suddenly and lasts for 2 to 3 weeks. Doctors think an infection with a virus may be the cause.

Meniere’s disease is condition that combines symptoms of dizziness with occasional hearing loss. Doctors aren’t sure what causes it, though stress can be a trigger, along with eating salt or drinking caffeine and alcohol.

There are some other conditions of the inner ear that also lead to peripheral vertigo, including:

• Labyrinthitis
• Perilymph fistula
• Superior semicircular canal dehiscence syndrome (SSCDS)

Labyrinthitis may be caused by a viral infection of your inner ear. Perilymph fistula may be due to a head injury or sudden pressure change, such as from scuba diving. SSCDS may be due to a breakdown of part of a bony part of a canal that carries fluids in your inner ear.

Nausea and vomiting, sweating, and ear problems are all common symptoms that you may have along with vertigo.

If your peripheral vertigo is caused by an inner ear infection or a disease, you may have some pain or a feeling of fullness in your ear.

In labyrinthitis and Meniere’s disease, you may have hearing loss and tinnitus (ringing of the ears) in one or both ears along with the vertigo.

There are some common features of peripheral vertigo that can help your doctor make a diagnosis. Vertigo that starts without warning, and stops just as quickly, is more likely to be peripheral vertigo.

Your eyes may also move without your control. This movement may go away when you try to focus your vision on a fixed point. It also tends to only happen during the first few days of vertigo symptoms and then disappears.

You can treat peripheral vertigo by managing the condition that’s causing it.

BPPV, the most common cause of peripheral vertigo, can be treated with a 15-minute exercise known as the Epley maneuver. This series of movements, done in your doctor’s office, helps return the crystals that control balance to the correct place in your inner ear.

Anti-inflammatory drugs can sometimes help ease symptoms if your peripheral vertigo is caused by vestibular neuronitis, Meniere’s disease, or labyrinthitis. Meniere’s disease can also be controlled by cutting down on salt, caffeine, and alcohol and lowering your stress.

For some conditions, such as perilymph fistula or SSCDS, your doctor may recommend surgery to correct problems in your inner ear.

Some conditions causing peripheral vertigo may be chronic, meaning they are ongoing. In these situations, you’ll need a combination of balance exercises, lifestyle changes, and medication to manage the vertigo. Motion sickness medicine may also help ease nausea. Your doctor may also prescribe medicines that help reduce balance problems.

Central vertigo is caused by a disease or injury to the brain, such as:

• Head injuries
• Illness or infection
• Multiple sclerosis
• Migraines
• Brain tumors
• Strokes
• Transient ischemic attacks (“mini” strokes that last for a short time and don’t cause permanent damage)

While episodes of peripheral vertigo tend to pass quickly, central vertigo often comes without warning and may last for long periods of time. The episodes are generally much more intense than peripheral, and you may be unable to stand or walk without help.

Eye movement that you can’t control happens in both types of vertigo. But in central vertigo this eye movement lasts longer (weeks to months during vertigo episodes) and it does not go away when you’re asked to focus on a fixed point.

The hearing problems that frequently happen in peripheral vertigo or AICA strokeare rare with central vertigo. But other symptoms — like headaches, weakness, or trouble swallowing — are common with central vertigo.

Finding out the root cause of the vertigo and treating it is the only way to manage central vertigo. If migraines are the cause, for instance, medication and reducing your stress may help.

For some ongoing conditions, such as multiple sclerosis stroke, and some tumors, treatment may consist of managing the symptoms. This may include medicines for nausea and drugs that help lessen the sensation of movement.

A stroke in the brain can trigger not only vertigo but dysarthria (slurred speech), ataxia (problems moving), weakness, and numbness/tingling. You should get emergency help right away.

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Vertigo – Causes – Differential Diagnosis – Management

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Last updated: May 16, 2020
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Last updated: May 16, 2020
Revisions: 14

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• 1 Benign Positional Paroxysmal Vertigo
  • 1. 1 Management
• 2 Meniere’s Disease
  • 2.1 Clinical Features
  • 2.2 Management
• 3 Vestibular Neuronitis
  • 3.1 Clinical Features
  • 3.2 Management
• 4 Key Points

Vertigo is the hallucination of movement*. Whilst aetiology varies, all causes of vertigo produce a conflict between the vestibular input and other sensory inputs of balance (proprioception and vision) resulting in the sensation of vertigo

The causes of which can be divided into central or otological:

• Central causes of vertigo include multiple sclerosis, posterior stroke, migraine, or intracranial space occupying lesion
• Otological causes of vertigo include Benign Positional Paroxysmal Vertigo, Meniere’s Disease, and Vestibular Neuronitis

*Many patients will complain of symptoms of dizziness or light-headedness, yet this is not true vertigo

Adobe Stock, Licensed to TeachMeSeries Ltd

Figure 1 – The hallucination of movement felt with vertigo

Benign Positional Paroxysmal Vertigo

Benign Positional Paroxysmal Vertigo (BPPV) is caused by the presence of canaliths in the semi-circular canal instead of the utricle (Fig. 2).

Once in the canal, movement of the patient’s head will result movement of these crystals that cause an abnormal movement of endolymph, resulting in vertigo. BPPV can occur in patients following a head injury, previous history of labyrinthitis, and older patients.

In BPPV, vertigo attacks last seconds and result from the same head movement causing the onset of symptoms every time. Accompanying symptoms typically include nausea and vomiting.

By Francesca Leone, TeachMeSurgery [CC-BY-NC-ND 4.0]

Figure 2 – Formation of crystals and their migration into the semi-circular canals in BPPV

Management

The diagnostic examination for BPPV is the Dix-Hallpike manoeuvre, with a positive test invoking the symptoms and nystagmus* will be present. The nystagmus fatigues in less than a minute.

Once the condition is diagnosed, specific manoeuvres can be employed to remove the crystals from the canal and resolve the symptoms. A common manoeuvre is Epley’s Manoeuvre, performed if the canalith are in the posterior canal.

Patients post-Epley’s manoeuvre are advised not to drive, to keep sleep upright, not to bend down or look upwards for 48 hours. Resolution is not always complete, with some patients requiring repeated Epley’s as symptoms persist, and BPPV can also recur.

Patients can also be advised to perform Brandt-Daroff exercises, positions they can practice at home that are beneficial in reducing symptom intensity.

*Most commonly crystals form in the posterior canal, resulting in a rotatory nystagmus to be present; if in the horizontal canal then result in a horizontal nystagmus.

Meniere’s Disease

Meniere’s Disease is an idiopathic disorder causing vertigo. Current theories in its pathophysiology suggest the symptoms result from an increase in endolymphatic pressure.

Caused by dysfunctioning sodium channels, an osmotic gradient is subsequently set up that draws fluid into the endolymph, increasing the endolymphatic pressure to cause symptoms.

By TeachMeSeries Ltd (2020)

Figure 3 – The components of the membranous labyrinth

Clinical Features

Meniere’s disease presents with attacks comprised of a triad of severe paroxysmal vertigo, sensorineural hearing loss, and tinnitus.

Symptoms are predominantly unilateral, lasting for minutes to hours, and usually resolve within 24 hours. During remission between attacks, the symptoms will improve yet repeated attacks result in a sensorineural hearing loss that worsens over time.

Whilst the disease will burn out eventually with time, permanent sensorineural hearing loss can remain.

Management

Otoscopy will show a normal looking ear drum, audiometry will typically show a sensorineural hearing loss, and tympanometry will be type A (normal). In acute attacks, the vertigo and nausea symptoms can be reduced by a short course of prochlorperazine (a vestibular sedative), given either buccal or intramuscular.

Most importantly however, management requires sufficient prophylaxis between attacks. Patients should be advised suitable lifestyle advice (reducing salt or avoiding chocolate and caffeine) and regular betahistine medication.

If attacks persist despite prophylaxis, surgical intervention may be warranted. This can include intratympanic gentamicin injections, intratympanic steroid injections, endolymphatic sac destruction, or labyrinthectomy (now rarely performed).

Vestibular Neuronitis

Vestibular neuronitis is inflammation of the vestibular nerve, resulting in vertigo that lasts for days. Most cases are due to a viral infection, therefore a URTI precedes around half of the cases.

Clinical Features

Symptoms will be sudden onset and severely incapacitating, nearly always associated with nausea and vomiting.

On otoscopy, the ear drum will be normal and a horizontal nystagmus will be present when examining the eyes. Neurological examination will be unremarkable and the hearing for these patients will be normal.

Whilst most cases resolve fully within a week; long-term vestibular deficit after the acute episode can lead to unsteadiness over a period of weeks whilst the brain compensates for this.

Management

Most patients can be managed at home. During the acute episode, a patient may require vestibular sedatives (to be stopped after the acute episode), also considering intravenous fluids if the patient becomes dehydrated from vomiting.

If there are persistent problems due to vestibular hypofunction, then the patient may require longer term vestibular rehabilitation via Cawthorne-Cooksey exercises.

Key Points

• Vertigo can be divided intocentral and otological causes
• Main otological causes include Benign Positional Paroxysmal Vertigo, Meniere’s Disease, and Vestibular Neuronitis
• BPPV symptoms last second to minutes, Meniere’s Disease symptoms last minutes to hours, and Vestibular Neuronitis symptoms last days to weeks

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Causes, symptoms, diagnosis and treatment at the NCC JSC “Russian Railways”, with a branch of the Central Clinical Hospital No.

1.

Dizziness is an incorrect awareness of body position and movement. It can be a symptom of a wide variety of neurological and mental diseases, diseases of the cardiovascular system, eyes and ears.

Causes

True dizziness, or vertigo, is the illusion of movement of one’s body or objects around. This happens if you rotate quickly, for example, on a carousel. True dizziness is often combined with psychovegetative disorders: nausea, vomiting, blanching, sweating, anxiety. This is due to the close connections of the vestibular system with the autonomic nervous system.

However, dizziness is very often a symptom of some disease:

• If dizziness occurs when you try to stand up or turn abruptly and then gradually subsides, this may be a manifestation of autonomic dysfunction (vegetovascular, neurocirculatory dystonia).
• Very often dizziness accompanies migraine.
• Any discharge from the ear, hearing loss may indicate inflammation of the inner ear.
• In Meniere’s syndrome (disease), dizziness is accompanied by tinnitus, nausea, vomiting, hearing loss. If there is no disorder in the auditory function, then this may be a manifestation of vestibular neuritis. For him, in addition to severe dizziness, a sudden onset, constant vomiting, a feeling of rotation, aggravated by trying to get up and moving the head, are characteristic.
• With sudden unilateral deafness, tinnitus and vomiting, as well as in milder cases, manifested by varying degrees of dizziness and hearing disorders (tinnitus, hearing loss), perilymphatic fistula is diagnosed.
• In case of unilateral hearing loss and dizziness, it is necessary, first of all, to exclude brain tumors. Such dizziness begins gradually and is often accompanied by gradually increasing headaches. Characterized by increased dizziness in certain positions of the body.
• Transient cerebrovascular accident and stroke are characterized by an acute onset, a combination of dizziness with double vision, sensitivity disorders, weakness in the arms and legs, and impaired coordination of movements. The dizziness may last for several days.
• If dizziness is accompanied by instability, a feeling of disorientation in space, increases with movements, especially sudden ones, in the cervical spine (flexion, extension, turns to the side), pain and limitation of mobility in the cervical spine, then the most common cause of such dizziness is cervical disease. spine section.
• The cause of dizziness may be a traumatic brain injury.
• Dizziness can be caused by certain medications, such as antibiotics or high blood pressure medications, especially when taken in excess.
• The most common cause of dizziness is motion sickness (or motion sickness) that occurs when moving in air, sea, and road transport.
• In agoraphobia (a syndrome of fear of open spaces), dizziness occurs when you are in crowded places, and in severe cases, even when you need to leave the house.

Diagnosis

If you experience frequent dizziness, you should contact a neurologist and an otolaryngologist. The diagnostic program may include computed or magnetic resonance imaging of the brain, Doppler ultrasound of the brachiocephalic arteries, vestibular tests (caloric test, rotational tests). To diagnose a possible disease of the hearing aid, tone threshold audiometry, acoustic impedancemetry may be needed.

Treatment

The treatment of vertigo depends on its cause, and only after its clarification is the choice of treatment strategy for the disease made. In mild cases, the symptoms of the disease can regress by themselves when the provoking factor disappears or when the vestibular apparatus and the nervous system compensate for the disease itself. In severe cases, treatment may include drug therapy, exercise (special exercises for vestibular training), and sometimes surgery. Surgical treatment is indicated for brain tumors, serious head injuries.

For more information and to make an appointment, please call our contact center: (495) 925-02-02 (24/7).

Dizziness is not always a sign of success

Dizziness (vertigo) can be defined as a sensation of a disturbed orientation of the body in space (meaning the illusion of rotation of a person or surrounding objects). Vertigo is the most famous painting by the Belgian artist Léon Spilliart (1908).

“Vertigo” shows the fear of the abyss of a woman trying to descend the steps. Everything looks like a nightmare from which you cannot escape…

Dizziness affects about 5.2% of the population every year. At the same time, in 80% of cases, this condition makes people seek medical help.

Currently, about 80 diseases have been described that have dizziness as a symptom. However, in about 40% of cases, a definite diagnosis is not made.

Dizziness occurs when any of the three anatomical systems responsible for body balance in space are stimulated: visual, vestibular and deep sensitivity. Their stimulation is possible both in the norm (for example, when rotating on a carousel, climbing to a height, etc. ( physiological dizziness )), and in pathology (dizziness can be a symptom of a variety of diseases) ( pathological dizziness ).

A series of paintings by the Italian artist Fabio Gianpietro called “Vertigo” fully justifies itself. From now on, in order to feel a free fall, you will not need to jump with a parachute. It is enough just to look at his paintings from a height …

Dizziness is divided into vestibular (systemic) and non-vestibular (non-systemic). Vestibular dizziness (true dizziness) occurs in 25% of cases and is caused by damage to the vestibular analyzer from the labyrinth to the cortical regions of the brain. Vestibular vertigo is manifested by the illusion of movement of one’s own body (sensation of one’s own movement) or surrounding objects (sensation of external movement), which is usually accompanied by autonomic symptoms (nausea, vomiting, increased sweating), imbalance and nystagmus. The picture shows the painting “Vertigo” by the Iranian artist Iman Maleki.

Iman is one of the few contemporary artists who develops the direction of photorealism in the East. His paintings are distinguished by high detail and vivid exposure, allowing to achieve the effect of the surrounding reality.

Non-vestibular dizziness (non-systemic dizziness) occurs in 67% of cases and includes a feeling of “lightheadedness”, “veil before the eyes”, “blurring of objects”, an approaching loss of consciousness. The cause of the development of this type of dizziness can be fainting, side effects of drugs, as well as some mental illnesses.

It is always interesting to watch how artists depict the world around them through the prism of their own perception. Swiss artist Andy Denzler sees everything that happens around him in his own way. And this world seems somehow ghostly, blurry – like a reflection in the water, which is about to disappear, because the wind blew and ripples went through the water. All this creates a feeling of insecurity and anxiety.

Vestibular vertigo, in turn, is divided into peripheral (damage to the labyrinth, vestibular nerve, i.e. otogenic lesion) and central (damage to the vestibular nuclei of the brain stem, vestibular connections and vestibular centers of the brain).

The most common cause of peripheral vestibular vertigo is benign paroxysmal positional vertigo, Meniere’s disease, and vestibular neuronitis.

Benign paroxysmal positional vertigo (BPPV) accounts for 34.3% of all cases of vertigo. The development of the disease is presumably based on the deposition of calcium carbonate crystals in the semicircular tubules of the labyrinth, which leads to an increase in the sensitivity of vestibular receptors to changes in head position. BPPV is manifested by “quick” attacks of dizziness (a few seconds or minutes), which occur only when the position of the head changes (especially when it tilts back and forth). Often, patients know at what position of the head dizziness occurs (“the room has gone”). Quite often in patients with benign paroxysmal positional vertigo, anxiety disorders and depression occur, which largely explains the complaints of patients about “instability”.

Dizziness in Meniere’s disease occurs in 5.9% of all vertigo cases. Local vasomotor disorders in the vessels of the labyrinth lead to the development of the disease, as a result of which the production of endolymph (“endolymphatic dropsy”) increases paroxysmally, which has an irritating effect on the vestibular receptors. Meniere’s disease is characterized by periodic attacks of severe dizziness (from 1-3 to 5-6 hours (it can last up to 12-24 hours)). Dizziness is combined with auditory disturbances, which are manifested by ear congestion, a feeling of fullness, “bursting” in the ear, noise, ringing, and hearing loss.

When Vincent van Gogh cut off his right ear, he was declared insane. In 1979, the Japanese otiatrist K. Yasuda, in one of his articles entitled “Did Van Gogh suffer from Meniere’s disease?”, was the first to raise the issue of inner ear dysfunction in the famous artist.

The discovered letters of Van Gogh, with amazing accuracy, demonstrate the most severe attacks of dizziness, typical of Meniere’s disease. They were accompanied by nausea, uncontrollable vomiting, tinnitus, and alternated periods during which he was completely healthy. At the time of the artist, such a disease was not yet known, and therefore it was believed that these symptoms are caused by epilepsy or a mental disorder.

Vestibular neuronitis accounts for 4.3% of all vertigo cases. The development of the disease is associated with selective inflammation of the vestibular nerve. As the causes of vestibular neuronitis, a viral infection (chickenpox, herpes zoster, mumps) is assumed, the manifestations of which are observed in half of the patients before the development of the disease. Vestibular neuronitis is manifested by a sudden prolonged (for several hours or days) attack of dizziness. Dizziness is often accompanied by nausea, vomiting, and imbalance. Patients endure this condition extremely hard and often do not get out of bed (any movement of the head or body can increase dizziness).

Vestibular vertigo of central origin is manifested in stroke. In this case, in addition to an attack of dizziness, other neurological symptoms of brain damage should be present (motor disorders, sensory disorders, impaired speech, swallowing, etc.).

The stroke influenced the work of the famous movie poster designer Reynold Brown. During his career, he managed to make more than 250 posters that were dramatic and fantastic. According to contemporaries, in the hands of the designer, the poster became like a work of art, and not like an advertising tool. But due to a severe stroke with the development of hemianopia, he had to stop working on posters, as he could no longer paint portraits. However, Brown discovered his talent as a landscape painter.

Dizziness is one of the ten most common complaints presented by patients with psychogenic disorders (depression, anxiety): you and so on.

Psychogenic vertigo is unlike any other known condition and does not reproduce with known provocative tests. Psychogenic dizziness is almost obligately accompanied by pronounced affective (fear and anxiety) and vegetative (cardiac and respiratory) phenomena.

Depression (from Latin – suppression) is characterized by a pathologically low mood (hypothymia) with a negative, pessimistic assessment of oneself, one’s position in the surrounding reality and one’s future.

American abstract artist Mark Rothko’s reputation is largely due to his famous images of brightly colored rectangles. At first glance, his paintings seem static, but after staring at them for a few minutes, the image begins to move and pulsate. Rothko himself believed that his paintings invite you on an “unpredictable journey into an unknown dimension.” Toward the end of his life, the artist’s paintings became less bright and saturated, and his last work was an untitled painting in black and gray (1970). After a divorce from his wife, Rothko suffered from severe depression …

Anxiety is an emotional experience of discomfort from an uncertain perspective.

Psychological and sociological conflicts are what inspires Canadian artist Adam Lupton. Portraits from his collection are like long exposure photographs – different poses seem to show the dynamics. But, unlike photographs, Lupton’s works do not convey the movement of the body, but the movement of thoughts, experiences. Adam’s paintings are in oil, he tries to avoid clear contours, uses pastel colors, the figures are blurry, translucent, so it is difficult to focus on one thing. Just such a state is experienced by a person in a state of stress, anxiety.

autonomic nervous system. In the structure of anxiety disorders accompanied by dizziness, the leading place is occupied by panic disorders. However, psychogenic dizziness can also occur after an attack of real dizziness.

The main direction of therapeutic measures is to eliminate the possible causes of dizziness. So, for example, with BPPV, the doctor, using special Frenzel glasses, performs therapeutic maneuvers.

The basis for restoring the function of the vestibular system is special (vestibular) gymnastics. The basic principle of vestibular gymnastics exercise complexes is to “accustom” the brain to stimuli so that in the future it becomes possible to ignore them. This type of gymnastics is especially useful, because it not only helps to remove negative factors, but also teaches people to live in a state of dizziness.

Pablo Picasso’s Girl on a Ball depicts a traveling troupe of acrobats. Almost the entire canvas is occupied by two: a fragile gymnast is rehearsing a circus number, balancing on a ball, and a powerful athlete is sitting nearby, relaxing. The picture is filled with inner drama, which is the basis of the composition of the picture, and is built on a comparison of contrasts. The contrast of movement and stillness is played out.

Recommendations for patients with dizziness

1. If you experience dizziness when changing position or getting out of bed, take your time: first sit up slowly in bed, wait a few minutes to make sure that your head is not spinning. Get up slowly, leaning on the edge of the bed. Start moving only after making sure that the head is not spinning in the standing position.
2. Perform a set of vestibular exercises in the regimen prescribed by your doctor. If you can increase your physical activity, Nordic walking, swimming, ball games, dancing or any other sport that you enjoy is suitable
3. Create a safer environment in your home by removing carpets, telephone and electrical wires from the floor, using a cordless telephone, installing safety rails in showers and baths. There must be a lamp next to your bed that you can light and extinguish without getting out of bed. Do not move around the apartment in the dark, if necessary, leave electric lighting for the night
4. Use a handrail or at least lean against a wall when going up and down stairs.
5. Try to avoid crowded places. If you still visit such places (theater, stadium, etc.), try to take an accompanying person with you. Feel free to use a cane if you feel uncomfortable walking.
6. When visiting the theater, choose seats closer to the center of the stage so that you can see what is happening without having to turn your head from side to side.
7. In public places (e.g. a bar), avoid loud music, shiny surfaces, colorful wallpapers, or try to sit on the edge, away from the crowded central area with visitors, waiters, etc.
8. Wear sunglasses if bright light makes you dizzy and causes headache. Hypersensitivity to visual stimuli is a frequent companion of vestibular disorders.
9. Try to reduce the level of stress and anxiety in your life. Learn to be more calm about the events that you cannot change.