Laryngeal vertigo is a transient disturbance of consciousness that occurs at the peak of a coughing fit. The syndrome is manifested by cough syncopations: short-term twilight consciousness, fainting or deep loss of consciousness, sometimes accompanied by convulsions, involuntary urination and defecation. Methods of diagnosis of laryngeal vertigo include questioning, examination of the patient, functional tests, instrumental studies (electrocardiography, electroencephalography, bronchoscopy). Treatment involves symptomatic therapy that facilitates the patient’s condition and is aimed at eliminating the manifestations of the underlying disease.
ICD 10
R55 Fainting [syncope] and collapse
General information
Pathology is observed quite rarely, it makes up no more than 2% of cases from among all types of paroxysmal conditions. Laryngeal vertigo can occur under the names “cough-brain syndrome”, “cough syncopation”, “laryngeal dizziness”, “respiratory seizure”, “cough syncope”. It is more often observed in people with pulmonary-cardiac insufficiency. Mostly men aged 45 and older suffer.
Causes
The condition occurs against the background of acute or chronic hypoxia of brain tissues. Its immediate cause is a sharp aggravation of the already existing lack of oxygen caused by cough paroxysm. Pathology can manifest itself in the following diseases:
- Chronic pulmonary pathologies (pulmonary heart, asthma, tuberculosis, emphysema of the lungs). With these diseases, stagnation occurs in the small circle of blood circulation, and pulmonary heart failure develops in the future. With decompensated course, encephalopathy may develop with a tendency to convulsive fainting.
- Airway obstruction (aspiration of foreign bodies, whooping cough, acute laryngitis). It is accompanied by acute cerebral hypoxia and prolonged bouts of severe coughing, which cause episodes of cough fainting.
- Cerebrovascular disorders. Changes in cerebral vessels (vascular malformations, compression of intracranial and extracranial veins, the consequences of TBI) cause venous hyperemia of the brain, which can be accompanied by fainting seizures. Disorders of the blood supply to the brain in the pathology of extra- and intracranial arteries (cerebral atherosclerosis, vertebral artery syndrome) threaten the development of a number of vestibular disorders, including loss of consciousness.
- Lesions of peripheral nerves. With neuralgia of the upper laryngeal nerve, pathological impulses lead to activation of the vagus nerve center and bradycardia. The volume of cardiac output decreases sharply, brain ischemia and fainting occurs.
Risk factors in the development of seizures of impaired consciousness are smoking, drug addiction, overweight. When intoxicated with alcohol and narcotic drugs, changes occur in the brain, its membranes and cerebrospinal fluid, leading to disruption of the respiratory and cardiovascular systems.
Pathogenesis
The pathogenesis of laryngeal vertigo has not been fully elucidated. Usually, paroxysmal conditions that occur at the height of the cough reflex have nothing to do with epilepsy. The hemodynamic theory explains the most complete changes that occur during coughing. There are three phases of cough: inspiratory, compressive and expiratory. In the compression and expiratory phases, intra-thoracic and intra-abdominal pressure sharply increases, resulting in reduced blood flow to the heart. This leads to a decrease in cardiac output and changes in the pressure of the cerebrospinal fluid in the brain and spinal cord. As a result of a sharp increase in intra-thoracic pressure, it increases in the peripheral arteries, veins and chambers of the heart, which leads to venous stagnation and causes laryngeal vertigo.
There are other mechanisms of development: stimulation of vagus nerve receptors, carrying out pathological impulses from the reflexogenic areas of the respiratory tract and jugular veins. Such effects lead to changes in the work of the reticular formation, which is fraught with vasodepressor reactions and sharp bradycardia with impaired consciousness.
Classification
Laryngeal vertigo syndrome has not been fully studied. Despite the high prevalence of diseases and conditions accompanied by cough, this symptom complex is rare. Its course can be grouped by clinical manifestations:
- Short-term twilight disorder of consciousness. It usually lasts a few seconds and does not require emergency assistance. In this case, the underlying disease that caused this condition should be treated.
- Short fainting at the height of coughing. Most often it lasts from 2 to 10 seconds. Therapy of the underlying pathology is necessary.
- Prolonged loss of consciousness. It is complicated by convulsions, involuntary urination, defecation. It is often combined with organic brain damage with persistent consequences. Aggravating factors are alcohol, nicotine intoxication, poisoning with narcotic drugs.
Symptoms
Clinical manifestations may differ not only in different patients, but each attack in a single patient may acquire different variants of the course. Paroxysmal states – cough syncopations – occur at the peak of the cough reflex. Similar symptom complexes are also observed when laughing, sneezing, straining, lifting weights, etc. They may be preceded by prodromal phenomena (presyncopal states) in the form of dizziness, tinnitus, visual disturbances, facial hyperemia, subsequently replaced by cyanosis, swelling of the neck veins when coughing. In some cases, some harbingers may be missing.
Laryngeal vertigo is accompanied by attacks of severe convulsive cough, at the height of which there are signs of impaired consciousness or fainting. Usually, the occurrence of an attack is not related to the position of the body. Coughing can provoke a sharp smell, cold air. The duration of twilight consciousness or deep fainting varies from a few seconds to 2-5 minutes. At the peak of coughing, loss of consciousness is usually accompanied by a fall, most often patients recover without assistance.
Sometimes laryngeal vertigo can be accompanied by convulsions that are local in nature: for example, twitching of the upper or lower extremities. The skin becomes grayish-bluish, there is profuse sweating. Biting of the tongue during an attack is usually not observed. In rare cases, laryngeal vertigo leads to urinary and fecal incontinence. With organic brain lesions, cough syncopations can be replaced by small epileptic seizures that do not depend on cough.
In the postsyncopal period, neck pain and headache may be felt. The patient complains of general weakness, dizziness, which pass over time. The state of deafness and memory loss observed during epiprimes are not characteristic of laryngeal vertigo. In the absence of aggravating factors, the consequences do not cause mental disorders.
Complications
With laryngeal vertigo, complications rarely occur. They are usually associated with the underlying disease that caused the syndrome. One of the serious consequences is the increasing pulmonary heart failure. Circulatory disorders in the brain can lead to persistent damage to cerebral tissue – hypoxic encephalopathy. During cough fainting, there is a risk of injury if you fall from a height of your own height.
Diagnostics
For the correct diagnosis, a comprehensive clinical and instrumental examination is required to identify the cause of cough syncopations, as well as to differentiate them from other diseases. The diagnostic algorithm includes:
- Consultations of specialists (therapist, neurologist, pulmonologist, cardiologist). At the reception, the history of the disease, the nature of the attacks, their connection with cough are studied. Great importance is attached to physical methods. During the examination, attention is drawn to the general condition of the patient, the features of the constitution (tendency to obesity).
- Vagal tests (Valsalva test, test with pressure on the carotid sinus). They are carried out in order to simulate the pathogenetic mechanisms of the syncopal state.
- EPI of the cardiovascular system. ECG allows you to identify pathological processes in the heart, indicating the presence of pulmonary heart failure. In some cases, stress tests and daily ECG monitoring are used.
- EEG. It makes it possible to record pathological impulses emanating from certain areas of the brain, which is extremely important for the exclusion of organic cerebral lesions. Functional tests are used to identify foci of convulsive activity.
- Methods of assessment of the bronchopulmonary system (radiation diagnostics, endoscopy of the respiratory tract). Lung x-ray is used to detect chronic diseases of the respiratory system, pulmonary heart. Tracheobronchoscopy is used to detect and extract foreign bodies of the trachea and bronchi.
During differential diagnosis, loss of consciousness caused by orthostatic hypotension, occlusion of cerebral vessels, epilepsy should be excluded. Episodes of loss of consciousness in these conditions have nothing to do with the cough reflex.
Treatment
During an attack, at the stage of pre-medical care to the patient, it is necessary to ensure the flow of arterial blood enriched with oxygen to the brain. To this end, it is necessary to lay the patient on his back, lower his head and lift his lower limbs, provide free breathing and access to fresh air.
Medical care consists in measures aimed at reducing congestion in the brain, eliminating disorders of the cardiovascular system by introducing cardiotonics, vasoconstrictors, as well as drugs that improve bronchial patency. With bradycardia, atropine is administered. In the future, the patient may be hospitalized in the department of neurology or pulmonology for the treatment of the underlying disease.
Prognosis and prevention
To prevent paroxysmal conditions, it is necessary to monitor your health, if symptoms of laryngeal vertigo occur, seek medical help in a timely manner. The diet is of great importance, since overweight is one of the risk factors. It is necessary to avoid conditions that contribute to the development of fainting: prolonged cough, fatigue, prolonged stay in a standing position, strong tension, sudden movements of the head. Full-fledged rest, gymnastics and sports, hardening have a beneficial effect on the body.
