Vertigo

Vertigo is a sensation of spinning or whirling, either of oneself or of the surroundings, even when standing still. It is often described as a feeling of dizziness, but it is distinct from lightheadedness or faintness. Vertigo is typically a symptom of an underlying problem with the inner ear, brain, or sensory nerve pathways.

Causes:

Vertigo can be caused by problems in the inner ear (peripheral vertigo) or in the brain or central nervous system (central vertigo).

• Peripheral Vertigo (most common, problems in the inner ear):
  • Benign Paroxysmal Positional Vertigo (BPPV): The most common cause, triggered by specific head movements. It occurs when tiny calcium carbonate crystals (otoconia) in the inner ear’s utricle become dislodged and move into one of the semicircular canals.
  • Ménière’s Disease: A disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), hearing loss, and a feeling of fullness in the ear.
  • Labyrinthitis: Inflammation of the labyrinth (part of the inner ear) usually caused by a viral infection, leading to sudden, severe vertigo, nausea, and sometimes hearing loss.
  • Vestibular Neuritis: Inflammation of the vestibular nerve (which sends information about head movement to the brain), typically caused by a viral infection, resulting in sudden, severe vertigo without hearing loss.
  • Head injury: Trauma to the head can damage the inner ear or vestibular nerve.
  • Certain medications: Some drugs can be ototoxic (damaging to the inner ear) and cause vertigo as a side effect.
• Central Vertigo (problems in the brain or central nervous system):
  • Stroke: Can affect parts of the brain involved in balance.
  • Migraine: Some types of migraine can cause vertigo, known as vestibular migraine.
  • Multiple Sclerosis (MS): A neurological disorder that can affect balance pathways in the brain.
  • Brain tumors: Tumors in the cerebellum or brainstem can cause vertigo.
  • Transient Ischemic Attack (TIA): A “mini-stroke” that temporarily disrupts blood flow to the brain.

Symptoms:

The primary symptom of vertigo is the sensation of spinning or moving. Other symptoms that may accompany vertigo include:

• Feeling unbalanced or unsteady
• Nausea and vomiting
• Dizziness
• Lightheadedness
• Abnormal eye movements (nystagmus)
• Headache
• Ringing in the ears (tinnitus)
• Hearing loss
• Sweating
• Double vision or difficulty speaking (more common with central vertigo)
• Weakness in limbs (more common with central vertigo)

Diagnosis:

Diagnosing the cause of vertigo involves a thorough medical history, physical examination, and specific tests to assess balance and inner ear function.

• Medical history and physical exam: The doctor will ask about your symptoms (when they started, how long they last, what triggers them), any associated symptoms, and your medical history. They will perform a neurological exam and assess your balance and gait.
• Dix-Hallpike maneuver: For suspected BPPV, the doctor moves your head in specific ways to try and trigger vertigo and observe eye movements.
• Vestibular tests:
  • Videonystagmography (VNG) or Electronystagmography (ENG): Measure eye movements to assess inner ear and brain function.
  • Rotary chair test: Measures eye movements in response to chair rotation.
  • Vestibular evoked myogenic potentials (VEMPs): Measure responses from neck muscles to sound, assessing inner ear function.
• Hearing tests (audiometry): To check for hearing loss, especially if Ménière’s disease is suspected.
• Blood tests: To rule out other conditions.
• Imaging tests:
  • MRI (Magnetic Resonance Imaging) or CT scan: May be ordered to look for problems in the brain (e.g., stroke, tumor, MS) if central vertigo is suspected.

Treatment:

Treatment for vertigo depends on the underlying cause.

• For BPPV:
  • Canalith Repositioning Maneuvers (e.g., Epley maneuver): A series of specific head movements performed by a healthcare professional to move the dislodged crystals back into place in the inner ear.
• For Ménière’s Disease:
  • Dietary changes: Low-salt diet.
  • Medications: Diuretics (to reduce fluid buildup), anti-vertigo medications (e.g., meclizine), anti-nausea medications.
  • Injections or surgery: In severe, refractory cases.
• For Labyrinthitis or Vestibular Neuritis:
  • Medications: Anti-vertigo medications (e.g., meclizine), anti-nausea medications, corticosteroids (to reduce inflammation), antiviral medications (if viral cause confirmed).
  • Vestibular rehabilitation therapy (VRT): Exercises to help the brain adapt to and compensate for inner ear imbalances.
• For Central Vertigo:
  • Treatment focuses on addressing the underlying neurological condition (e.g., stroke rehabilitation, migraine management, MS treatment).
• General management:
  • Medications: Anti-vertigo drugs (e.g., meclizine, dimenhydrinate) and anti-nausea drugs (e.g., ondansetron) can help manage symptoms temporarily.
  • Vestibular rehabilitation therapy (VRT): A specialized form of physical therapy that involves exercises to help the brain learn to compensate for inner ear problems and improve balance.
  • Lifestyle adjustments: Avoiding sudden head movements, getting enough sleep, reducing stress, and avoiding triggers like caffeine or alcohol for some individuals.

It’s important to seek medical attention for persistent or severe vertigo, especially if accompanied by neurological symptoms, to determine the underlying cause and receive appropriate treatment.