Vertigo-associated disorders

Answer 1

Definition

Vertigo is a sensation of motion or spinning that is often described as dizziness.

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

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 back part of the brain (cerebellum).

Vertigo related to the inner ear may be caused by:

• Benign positional vertigo (also called benign paroxysmal positional vertigo)
• Drugs called aminoglycoside antibiotics
• Injury (such as head injury)
• Labyrinthitis
• Meniere's disease

Vertigo related to the vestibular nerve may be caused by:

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

Vertigo related to the brainstem may be caused by:

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

Symptoms

The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms from the condition causing the vertigo. Symptoms can include:

• Difficulty swallowing
• Double vision
• Eye movement problems
• 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, involuntary eye movements (nystagmus)
• Lack of coordination and balance, difficulty walking
• Hearing loss
• Weakness

Tests to determine the cause of vertigo may include:

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

Treatment

Medications to treat peripheral vertigo may include:

• Anticholinergics (such as scopolamine)
• Antihistamines (such as meclizine)
• Benzodiazepines (such as diazepam or lorazepam)
• Promethazine (to treat nausea and vomiting)

Benign positional vertigo is most often treated with physical maneuvers that help reposition small structures in the semicircular canals of the inner ear. This reduces or stops the vertigo.

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 lead to many injuries, including hip fractures.

Calling your health care provider

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

References

Baloh RW. Hearing and equilibrium. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 454.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, et al., eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005; chap 126.

Answer 2

Definition

Vertigo is a sensation of motion or spinning that is often described as dizziness.

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

Alternative Names

Peripheral vertigo; Central vertigo

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 back part of the brain (cerebellum).

Vertigo related to the areas in the inner ear that control balance (vestibular labyrinth or semicircular canals) may be caused by:

• Benign positional vertigo (also called benign paroxysmal positional vertigo)
• Drugs such as aminoglycoside antibiotics, cisplatin, diuretics, or salicylates
• Injury (such as head injury)
• Labyrinthitis
• Meniere's disease

Vertigo related to the problems with vestibular nerve may be caused by:

• Inflammation (neuronitis)
• Pressure on a nerve (most often due to a noncancerous tumor such as a meningioma or schwannoma)

Vertigo related to the brainstem may be caused by:

• Blood vessel disease
• Drugs (anticonvulsants, aspirin, alcohol)
• Migraine
• Multiple sclerosis
• Seizures(rarely)
• Stroke
• Tumors (usually benign)

Symptoms

The primary symptom is a sensation that you or the room is moving or spinning. The spinning sensation may cause nausea and vomiting in some people.

Other symptoms can include:

• Difficulty focusing the eyes
• Dizziness
• Hearing loss in one ear
• Loss of balance (may cause falls)
• Ringing in the ears

If you have vertigo due to problems in the brain (central vertigo), you will usually other symptoms from the underlying conditions. They may include:

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

Signs and tests

A physical exam may reveal:

• Difficulty walking due to loss of balance
• Eye movement problems or involuntary eye movements (nystagmus)
• Hearing loss
• Lack of coordination and balance
• Weakness

Tests to determine the cause of vertigo may include:

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

Treatment

Medications to treat peripheral vertigo may include:

• Anticholinergics (such as scopolamine)
• Antihistamines (such as meclizine or dimenhydrinate)
• Benzodiazepines (such as diazepam or lorazepam)
• Promethazine (to treat nausea and vomiting)

The cause of any brain disorder causing vertigo should be identified and treated when possible.

Persistent balance problems may improve with physical therapy. To prevent worsening of symptoms during episodes of vertigo, try the following:

• Keep still. Sit or lie down when symptoms occur.
• Gradually resume activity.
• Avoid sudden position changes.
• Do not try to read when symptoms occur.
• Avoid bright lights.

You may need help walking when symptoms occur. Avoid hazardous activities such as driving, operating heavy machinery, and climbing until 1 week after symptoms have disappeared.

Other treatment depends on the cause of the vertigo. Surgery may be suggested in some cases.

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 lead to many injuries, including hip fractures.

Calling your health care provider

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

References

Baloh RW, Jen J. Hearing and equilibrium.In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 436.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund VJ, et al., eds. CummingsOtolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 126.

Kerber KO, Baloh RW. Dizziness, vertigo, and hearing loss: Vascular malformations. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth Heinemann Elsevier; 2008:chap 18.

Reviewed By

Review Date: 10/30/2011

Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine and David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.