Vertigo-associated disorders Health Article

Definition

Vertigo is a sensation of motion or spinning that leads to dizziness and discomfort.

Vertigo is not the same as light-headedness. People with vertigo feel as though they are actually spinning or moving, or that the environment itself is spinning.

Causes, incidence, and risk factors

There are two types of vertigo:

• Peripheral vertigo occurs if there is a problem with the part of the inner ear that controls balance (vestibular labyrinth or semicircular canals) or with the vestibular nerve, which connects the inner ear to the brainstem.
• Central vertigo occurs if there is a problem in the brain, particularly in the brainstem or the cerebellum (back part of the brain).

Vertigo related to the inner ear may be caused by:

• Benign positional vertigo (recurrent attacks of vertigo, especially when the head is in certain positions)
• Drugs called aminoglycoside antibiotics
• Ménière's disease
• Labyrinthitis
• Injury

Vertigo related to the vestibular nerve may be caused by:

• Inflammation (neuronitis)
• Nerve compression (usually a benign tumor such as a meningioma or schwannoma)

Vertigo related to the brainstem may be caused by:

• Multiple sclerosis
• Blood vessel disease
• Migraine
• Drugs (anticonvulsants, aspirin, alcohol)

Symptoms

The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms associated with the condition that is causing the vertigo. Associated symptoms include the following:

• Double vision
• Difficulty swallowing
• Facial paralysis
• Slurred speech
• Weakness of the limbs

The spinning sensation may cause nausea and vomiting in some people.

Signs and tests

A physical exam may reveal eye movement problems, lack of coordination and balance, weakness, or sensory loss. These signs may suggest a central cause.

Nystagmus (involuntary eye movements) and hearing loss may be present in both central and peripheral vertigo.

Tests to determine the cause of vertigo may include:

• Head CT
• MRI scan of head and MRA scan of blood vessels of the brain
• Caloric stimulation (tests eye reflexes)
• Electronystagmography
• EEG, evoked auditory potential studies
• Lumbar puncture
• Blood tests

Treatment

Medications to treat peripheral vertigo may include:

• Antihistamines (such as meclizine)
• Anticholinergics
• Benzodiazepines
• Promethazine (to treat nausea and vomiting)

The cause of central vertigo should be identified and treated as appropriate.

Try to avoid head positions that cause vertigo. Use caution in situations such as driving, walking, or operating heavy equipment. Even short episodes of vertigo may be dangerous.

Expectations (prognosis)

The outcome depends on the cause.

Complications

Persistent, unrelieved vertigo can interfere with driving, work, and lifestyle. It can also cause falls which can in turn lead to hip fractures.

Calling your health care provider

Call for an appointment with your health care provider if vertigo is persistent or troublesome.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St. Louis, Mo: Mosby; 2005:3226.

Rakel P, ed. Conn’s Current Therapy 2005. 57th ed. Philadelphia, PA: WB Saunders; 2005:226-227.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, PA: WB Saunders; 2004:240-241.