Age : 40 years.

Education : graduated from the Moscow Medical Academy named after. I.M. Sechenov (now the First Moscow State Medical University named after I.M. Sechenov), courses at Utrecht University (Netherlands), Maastricht University (Netherlands), Ludwig Maximilian University of Munich (Germany).

Work : Clinic of Nervous Diseases named after. A. Ya. Kozhevnikova, Guta-Clinic medical center.

Regalia and titles : Candidate of Medical Sciences, author of more than 30 scientific publications, the monograph “Dizziness: diagnosis and treatment, common diagnostic errors” (co-authored with V. A. Parfenov and O. A. Melnikov).

About the most popular cause of dizziness

Patients come to me with dizziness, that is, I deal with a rather narrow area of neurology. There are many diseases that lead to dizziness. One of the most common is benign positional vertigo (otolithiasis). In the inner ear there is a so-called labyrinth, which is responsible for balance. The labyrinth is a very important part of the vestibular apparatus, and no one knows exactly how it works. This is a kind of space filled with liquid; pebbles and calcium carbonate crystals sometimes form in it. When a person moves his head (tilts it or throws it back), these crystals move, irritate the receptors and cause attacks of dizziness. There is even such a term - Sistine Chapel syndrome. Michelangelo painted a fresco on the ceiling of the Sistine Chapel, and visitors look at it with their heads raised. In this case, a person with otolithiasis becomes dizzy. No one knows where such crystals come from. But it is known for sure that their occurrence can be triggered by a head injury: the crystals break off from the so-called otolithic membrane, the structure responsible for the perception of gravity, and begin to float freely. Otolithiasis is treated with the help of special gymnastics: crystals move from one place of the vestibular apparatus to another and dissolve there.

About herpes, hearing loss and migraines

The head can also be dizzy due to herpes: the virus damages the vestibular nerve, and when hypothermia occurs, inflammation occurs. There is also Meniere's disease: attacks of dizziness occur more and more often, hearing acuity decreases, and tinnitus appears. The causes of this disease are unknown.

Migraines usually manifest themselves as headaches, but recently it turned out that they also cause dizziness. In this case, the person experiences dizziness (paroxysmal or prolonged), hearing is not impaired, and the head does not hurt (or rarely hurts). Vestibular migraine can affect both young and old. Conventional migraine medications help.

About alarmists

Sometimes people who complain of dizziness do not suffer from it at all. There are many panicky patients. There is even such a term - postural phobic instability. It is often caused by agoraphobia, when a person is afraid to leave the house, fear of open spaces. These patients go outside, begin to experience some kind of discomfort, it is difficult for them to characterize it, and they call it dizziness. Neurotic disorders are one of the main reasons for referrals. These include panic attacks and so-called somatized depression (with somatic, physical sensations). Such patients experience dizziness because a mental disorder contributes to the manifestation of hidden pathology of the vestibular system. In the absence of depression, this defect was easily compensated for and went unnoticed. It is worth asking in more detail - and it turns out that such patients often suffered from motion sickness in childhood, and even in adulthood they do not tolerate vestibular loads well.

If you experience dizziness, you should definitely see a doctor. In general, you need to go to doctors more often.

About a particularly narrow specialization

My dissertation partly concerned the stories of patients who had dizziness. I began to wonder why these people end up in the hospital. Their diseases were definitely benign, such patients differed from those who were in emergency departments: these patients did not have paralyzed arms or legs, and after two days their condition improved significantly. It quickly became clear that few people do this. And doing something that is not very common is always interesting.

Otoneurology is a bit of an unhappy field. It is at the intersection of neurology and otolaryngology. Dizziness is a problem that affects both the nervous system and ENT organs. Therefore, both neurologists and otolaryngologists should deal with dizziness, but usually one pushes this problem onto the other, and in general, neither one nor the other is very knowledgeable about the main causes of dizziness. Moreover, various tests and instrumental studies require special equipment, which is not available in a non-specialized clinic. That is, even if the doctor wants to make an accurate diagnosis himself, he will not always be able to do this - he will have to refer the patient to a clinic that has the necessary equipment.

There are only about seven otoneurologists in Moscow who are more or less immersed in the problem of dizziness. And in Western Europe there are not very many people who work on this topic: there are no more than ten major specialists. And there are still about twenty people in America. But still in the West there are specialized clinics and departments that deal only with vestibular disorders. I am now trying to create such a center here too, on the basis of a clinic for nervous diseases. This requires large financial investments and attracting sponsors, but it is worth it.

It seems to me that the existence of such highly specialized centers is justified. Dizziness is the second most common reason for visiting a doctor after pain. In older people, dizziness generally ranks first on the list of complaints. The cause is usually multisensory impairment: older people begin to see, hear, and feel worse, which causes balance disorders, that is, a feeling of dizziness.

About medical errors

Dizziness is often attributed to cervical osteochondrosis, which is an absolute mistake. Or for vertebrobasilar (vascular) insufficiency, which actually very rarely causes dizziness. Such diagnoses arise due to mechanical concepts: you turn your head and the blood vessels are pinched. Dizziness often occurs in older people, which means they can have vascular examinations done and see atherosclerosis, to which the symptoms are attributed. If this is a younger person, you can take X-rays of the spine and diagnose “osteochondrosis” (which, in fact, everyone has) and pass it off as the cause of dizziness.

Incorrect diagnosis often leads to incorrect treatment. For example, I had a patient who suffered from benign positional vertigo. She felt dizzy when she turned her head. Obviously, the doctors who first diagnosed her did not know about the existence of such a disease. They explained the dizziness by the fact that the vessels in her neck are being pinched: the woman turns her head, they are pinched, like a rubber hose, and the blood stops flowing to the brain, which makes her dizzy. This woman’s vessel was indeed tortuous, which, in fact, also occurs in healthy people. The patient underwent surgery and the vessel was straightened. Fortunately, the operation went without complications, but there was no improvement. Unfortunately, this is a fairly typical situation with dizziness: an incorrect diagnosis is made, vascular surgery is performed, but the dizziness remains.

Sometimes severe dizziness develops in young people. At the age of 25, a person experiences an attack of dizziness, caused, for example, by viral inflammation of the vestibular nerve. However, impressionable people, of course, get scared, call an ambulance, and she brings the patient to the emergency department. There he is diagnosed with a stroke. After a few days, the dizziness stops: the brain compensates for the nerve damage. The extract states: “stroke.” And a person at the age of 25 becomes, roughly speaking, branded. This is scary to live with because this disease is potentially fatal, and the person begins to think about the possibility of a second stroke. And the doctors had already explained to him: “This is a serious matter, you need to be careful, not to strain yourself.” Despite all the seemingly harmless nature of an incorrect diagnosis, it can cripple the rest of your life. If the patient later gets to a competent specialist, and he reports what actually happened to this patient, then shock and disappointment arises, a feeling of the meaninglessness of the fears that have existed for many years.

Every week I see at least one patient whose vestibular disease has either been misdiagnosed or missed as vascular. Such misdiagnosis leads to the fact that completely healthy people begin to feel terminally ill. One of my patients suffered from mild dizziness: her only problem was that it was difficult for her to weed the beds, and the neighbors laughed at her neglected garden. She was diagnosed with cervical osteochondrosis and admitted to the hospital. In fact, the only cause of dizziness was otolithiasis, which can be cured in a few minutes. Another patient of mine, before coming to me, was in the hospital 38 times in seven years - with each exacerbation.

About depression

If someone cannot be helped, it is most often patients with psychogenic dizziness. They simply don't believe what you tell them. Twenty doctors before me told the patient that his blood vessels were bad, but I claim that he has depression. This person leaves disappointed: “I won’t take antidepressants because I don’t have depression. I was counting on you, but you...” After this you feel unpleasant.

About specialists

It happens that a sick person comes, and I don’t know what’s wrong with him. Then I refer this patient to another doctor. This is what happens with a mathematical problem: you solve it, and nothing works, give it to someone else, and he immediately gives the answer. He just looked at the problem from a side that you hadn’t thought of.

About the systematic approach

I studied more from foreign books and short courses abroad. When I traveled like this, I realized that there are a lot of diseases that for some reason are rarely diagnosed here. Doctors often take a rather formal approach to making a diagnosis. When I started working, I did the same thing, chalking it all up to osteochondrosis and bad blood vessels. To avoid this, a systematic approach is needed. With us, each doctor treats in accordance with his experience and understanding of the nature of things. In the West, there is a more strict examination protocol and standards. If you come and say: “I have a sore throat,” you must undergo certain tests, this is mandatory. This approach guarantees more advanced diagnostics. But in Russia, if a doctor has seen a patient with a sore throat before you, then, by inertia, you are prescribed penicillin. Where I work, they use screening standards, which is very helpful: we can identify a disease that others have missed. Not because we are so smart, but because we try to use international experience and follow diagnostic and treatment protocols.

About education

We create educational programs and give a lot of lectures in Moscow and other cities. Yesterday I returned from Perm, a week ago I was in Krasnoyarsk - I usually go somewhere once a week or two. Mostly neurologists come to my lectures. It just so happens that our patients with dizziness mostly come to neurologists. In Italy, for example, people often go to ENT doctors. I don’t even know what my motives are for this educational activity. Probably ambition. I like it: they greet me, listen to me, ask questions. This is more important than money.

I would really like for applicants to take English when entering a medical university. In South Korea, upon admission to any higher education institution there is an English exam. In this country they want to be integrated into world science. The fact that many of our doctors do not speak English is an absolute disaster.

A lot of money is allocated for the development of medicine, but it is used to purchase equipment and make repairs in departments. This is good, but it will lead nowhere. We need to spend money on education. Then in twenty years we will have good doctors. A good doctor will do much more with old equipment than a bad one with ultra-modern equipment.

Doctors of a big city. Otoneurologist