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The main part of the vestibular apparatus is three semicircular canals and two sacs. The semicircular canals are located almost at right angles to buy careprost online, which makes it possible to record human movements in all planes. The channels are filled with liquid and have an extension - an ampulla. The ampoule contains a gelatin-like substance, cupula, which has a close connection with the receptors. The movements of the cupula, together with the flow of fluid inside the semicircular canals, create a sense of position in space in a person. The upper layer of the cupula may contain calcium bicarbonate crystals - otoliths.
Under certain conditions, spent and obsolete otoliths are not destroyed and float in the form of crystals in the fluid of the semicircular canals. The appearance of additional objects in the semicircular canals, naturally, does not go unnoticed. The crystals irritate the receptor apparatus (in addition to normal stimuli), resulting in a feeling of dizziness. When the crystals settle in an area under the influence of gravity (usually the area of the sacs), the dizziness disappears. The described changes are the main mechanism for the occurrence of BPPV.
Normally, otoliths are formed throughout life and then destroyed during the natural aging of the body. Destruction products are utilized by special cells. This situation is normal. BPPV is characterized by specific clinical features that form the basis for the diagnosis of this disease. So, BPPV is characterized.
BPPV is more common in people over 50 years of age. Perhaps by this time the natural processes of careprost pills of calcium bicarbonate crystals are slowing down, which is the reason for the more frequent occurrence of the disease at this age. According to statistics, women suffer from BPPV 2 times more often than men.
- In order to notice nystagmus during the test, it is recommended to use special Frenzel (or Blessing) glasses.
- These are glasses with a high degree of magnification, which eliminate the influence of arbitrary fixation of the patient's gaze. For the same purpose, a videonystagmograph or infrared recording of eye movements can be used.
Medical Staff Application
The clinical features of BPPV make it possible to come close to the correct diagnosis already at the stage of questioning the patient. Clarification of the time of onset of dizziness, provoking factors, duration of attacks, absence of additional complaints - all this suggests BPPV. However, more reliable confirmation is needed. For this purpose, special tests are performed, the most common and simple of which is the Dix-Hallpike test. The test is carried out as follows.
The patient is seated on the couch. Then turn (do not tilt!) the head in one direction (presumably towards the affected ear) by 45°. The doctor seems to fix the head in this position and quickly places the patient on his back, maintaining the angle of rotation of the head. In this case, the patient’s torso should be positioned in such a way that the head hangs slightly over the edge of the couch (that is, the head should be slightlywow tilted back). The doctor observes the patient's eyes (anticipating nystagmus) and at the same time asks about the feeling of dizziness.
In essence, the test is a provocative test for a typical attack of BPPV, since it causes displacement of crystals in the semicircular canals. In the case of BPPV, approximately 1-5 seconds after the patient is laid down, nystagmus and typical dizziness occur. The patient is then returned to a sitting position. Often, when returning to a sitting position, the patient again experiences a feeling of dizziness and nystagmus of less intensity and the opposite direction. This test is considered positive and confirms the diagnosis of BPPV. If the test is negative, then the test is performed with the head turned in the other direction.
