Patients Care

VERTIGO

Vertigo is actually a symptom or a sensation meaning whirling or spinning movement. Vertigo is an illusion of motion and is a problem seen increasingly in people as they age. It is usually temporary and a sign of some other problem or condition. Vertigo is a type of dizziness. It is often associated with nausea and vomiting as well as difficulties standing or walking. There are several different types of vertigo that are considered conditions: benign paroxysmal positional vertigo, central vertigo, peripheral vertigo and physiologic vertigo. Vertigo is one of the most common complaints for which people seek medical advice.

Causes

Vertigo can be caused by problems in the brain or the inner ear.

  • Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction. This type of vertigo is rarely serious and can be treated.
  • Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular neuritis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. The most common cause of labyrinthitis is a viral or bacterial inner ear infection.
  • Meniere's disease is composed of a triad of symptoms including: episodes of vertigo, ringing in the ears (tinnitus), and hearing loss. People with this condition have the abrupt onset of severe vertigo, fluctuating hearing loss, as well as periods in which they are symptom-free.
  • Acoustic neuroma is a type of tumor of the nerve tissue that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss.
  • Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed. The result is that the person's eyes gaze away from the side with the problem. Walking is also extremely impaired.
  • Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose.
  • Head trauma and neck injury may also result in vertigo, which usually goes away on its own.
  • Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache. There is often a prior history of similar episodes but no lasting problems.
  • Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can lead to lowered blood flow to the brain, causing vertigo symptoms.

Symptoms

Vertigo implies that there is a sensation of motion either of the person or the environment, often perceived as if the room is spinning around you. This should not be confused with symptoms of lightheadedness or fainting. Vertigo differs from motion sickness in that motion sickness is a feeling of being off-balance and lacking equilibrium, caused by repeated motions such as riding in a car or boat. If true vertigo exists, symptoms include a sensation of disorientation or motion. In addition, the individual may also have any or all of these symptoms:

  • nausea or vomiting,
  • sweating, and/or
  • abnormal eye movements.
The duration of symptoms can be from minutes to hours, and symptoms can be constant or episodic. The onset may be due to a movement or change in position.

Treatment

The choice of treatment will depend on the diagnosis.
  • Vertigo can be treated with medicine taken by mouth, through medicine placed on the skin (a patch), or drugs given through an IV.
  • Specific types of vertigo may require additional treatment and referral:
    • Bacterial infection of the middle ear requires antibiotics.
    • For Meniere's disease, in addition to symptomatic treatment, people might be placed on a low salt diet and may require medication used to increase urine output.
    • A hole in the inner ear causing recurrent infection may require referral to an ear, nose, and throat (ENT) specialist for surgery.
  • In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.
    • Vestibular rehabilitation exercises, also referred to as Epley maneuvers, consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo no longer occurs.
    • Particle repositioning maneuver is a treatment based on the idea that the condition is caused by displacement of tiny stones in the balance center (vestibular system) of the inner ear. The head is repositioned to move the stones to their normal position. This maneuver is repeated until the abnormal eye movements are no longer visible.