Vertigo is a condition in which one feels as though their environment is spinning. Vertigo can be caused by a vestibular disorder which is a group of disorders that affect how the vestibular system (the inner ear) function in regards to spatial information and balance. It can also be caused by infections and disorders of the central nervous system.
Definition & Facts
Vertigo is the feeling a person has that their environment is moving or spinning. It involves a perception of rotation. When the person feels as if they are moving, it is called subjective vertigo. When the person feels as if their environment is moving, it is called objective vertigo. Vertigo is different from dizziness, which involves feeling lightheaded, faint, and unsteady, because vertigo involves the illusion of movement.
Symptoms & Complaints
The symptoms can last from minutes to hours, and they can be constant or episodic. The patient may experience hearing loss and a ringing sensation in their ears (tinnitus). If a person has the following signs and symptoms, they may need to be evaluated in the emergency department:
- Sudden onset of symptoms
- Double vision (diplopia)
- Visual disturbances
- Difficulty speaking
- Altered level of consciousness
- Difficulty walking, lack of coordination, or weakness in the extremities (paresthesia)
There are many different causes of vertigo depending on the type of vertigo. There are two types of vertigo - peripheral or central. Causes of central vertigo relate to problems in the brain or spinal cord. Peripheral vertigo occurs as a result of problems with the inner ear.
The inner ear can become inflamed from illness, or small crystals or stones that normally occur within the inner ear can become dislodged and cause irritation. This condition is called benign paroxysmal positional vertigo.
Another possible cause of vertigo is Ménière's disease. This is caused by fluid that builds up in the inner ear. The reason for this is currently unknown. Traumatic head injuries can be the cause of damage to the inner ear, which can cause vertigo.
Rarely, a stroke, multiple sclerosis, or a tumor can cause vertigo. Factors that increase the risk of stroke can also increase the possibility of getting vertigo. Also, certain patients with a headache called a basilar artery migraine may experience vertigo.
Certain medications can also increase the risk. These include some anticonvulsant medications, antihypertensive drugs, antidepressants, and sometimes aspirin. Some people experience vertigo while drinking alcohol.
Diagnosis & Tests
A doctor evaluates vertigo by taking a full history of the symptoms of the patient. This includes taking note of any current medications, recent illnesses, and prior medical problems. The doctor is careful to get a comprehensive medical history of the patient because even problems that seem unrelated can be relevant.
After the doctor takes the history, they will perform a physical examination. This includes a full neurological examination. The doctor must determine if the cause is central or peripheral. Any new symptoms are taken note of to rule out the possibility of stroke. Abnormal eye movements and loss of coordination can help identify the underlying issue.
A test called the Dix-Halpike test may be administered. This test tries to recreate the symptoms of vertigo. The test abruptly repositions the patient's head, and then the doctor takes note of any symptoms that might occur. Sometimes, the doctor will perform a "roll test" instead. In this test, the patient lies flat, and their head is quickly moved from side to side. This may create the symptoms of vertigo for the doctor to observe.
Medical imaging tests may also be taken in certain cases. The doctor may order an magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain or inner ears. This is done to eliminate the possibility that the cause is a stroke or cancer. If the patient has any loss of hearing, then audiometry might be ordered.
Treatment & Therapy
Treatment for peripheral vertigo includes particle repositioning movements. The most common one of these treatments is the Eply maneuver. In this treatment, certain head movements can help to move the loose crystals in the inner ear. When the crystals are repositioned, they will be less of a source of irritation to the inner ear.
The Epley maneuver can help up to 90 percent of patients with the problem. Most patients with peripheral vertigo can be helped with treatment. If troubles persist, then it is a good idea to be evaluated to see if there is any other underlying issue that could be the cause of the symptoms.
There are also exercises that the patient can do. Cawthorne head exercises are a group of eye and head movements which can cause a decreased sensitivity of the nerves in the inner ear. This may improve vertigo. It is necessary for the patient to do these exercises frequently for there to be any relief.
There are medications for vertigo, but they are not recommended for long-term use. Meclizine is one of these drugs. The patient may take a benzodiazepine, such as valium, but the drug may make the patient sleepy. Other medications can be prescribed to control nausea and vomiting. Medication can relieve the symptoms of vertigo, but there is no known cure for the illness. Many times, vertigo can resolve itself within a few days.
Prevention & Prophylaxis
In the event of Ménière's disease, reducing salt intake might help resolve the symptoms. For peripheral vertigo, doing vestibular rehabilitation exercises might help prevent the problem. Maintaining general health can be helpful in decreasing the risks of getting the condition.