Vertigo is a symptom of a disease, not a disease specifically. Vertigo is a major symptom of balance disorders. Vertigo has been used to describe dizziness or a head rush. Vertigo is actually a sensation of spinning. The sensation of moving (when they eyes are shut) is referred to as subjective vertigo. Objective vertigo is the visual perception that an individuals surroundings are spinning.
Vertigo commonly occurs because of vestibular system impairment. The vestibular system is controlled by structures in the inner ear, brainstem, cerebellum and the vestibular nerve. The vestibular system is responsible for sensory integration, movement and for keeping the environment in focus while the body moves.
Vertigo is a common health problem in adults affecting 40% of the adult population in the United States at least one time during their life. Women have a higher chance of experiencing vertigo and this changes increases as a person gets older.
Symptoms of vertigo can be nausea or vomiting. If the vertigo is severe it can affect walking and standing.
Peripheral vertigo symptoms are:
Inability to concentrate
Fatigue and reduced stamina
Increased risk for motion sickness
Nausea and vomiting
Sensitivity to bright lights and noise
Central vertigo symptoms are:
Lack of coordination
Nausea and vomiting
Inability to speak due to muscle impairment (dysarthria)
Double vision (diplopia)
Headache (may be severe)
The cause of vertigo should be diagnosed as quickly as possible, especially if it is severe. Vertigo can be a symptom of stroke, hemorrhage, tumor or cardiovascular disease. A complete physical and neurological exam, blood tests and imaging should be performed for a correct diagnosis. The physical exam should include blood pressure and heart rate.
The positional vertigo test will determine if the vertigo is from peripheral or central vestibular system. In this test a patient sits on a table with the head turned to one side. The physician will support the patients head and the patient slowly lies back on the exam table. The physician will then examine the eyes for nystagmus, while the patient experiences vertigo. When there is a delay between nystagmus and the vertigo, the vertigo is defined as peripheral. When there is no delay, the vertigo is considered a central vestibular disorder. The test is then repeated with the head turned in the other direction.
A neurological test is used to evaluate the vestibular system, known as an electronystagmography (ENG). This test involves an audiometry test (hearing in both ears), eye movement tests and evaluating physical responses to changes in position and posture.
Blood tests consist of a kidney panel, thyroid panel and a complete blood count (CBC).
Imaging is used to detect abnormalities in the brain such as a stroke or tumor.
Signals are transmitted to the labyrinth of the inner ear when the head moves. The labyrinth is made up of three semicircular canals resting in fluid. The labyrinth sends a signal to the vestibular nerve about the movement. The vestibular nerve carries that signal to the brainstem and the cerebellum. The cerebellum and brainstem are the areas of the brain that monitor and control movement, balance, blood pressure, consciousness and coordination. There are a number of causes for vertigo.
Vertigo is most often caused by benign paroxysmal positional vertigo (BPPV). Vertigo can also be a sign of strokes, tumor or drug reactions.
Vertigo that is caused by damage to the vestibular pathway is divided into two classes. The classes are defined by the location of the damage in the vestibular pathway. The two classes are central and peripheral.
Central vertigo involves lesions on the brainstem vestibular nuclei. Central vertigo usually lasts for a specific time period and is less severe. Sometimes patients have nystagmus (temporary loss of vision or eye control) that can occur in many directions. Symptoms that also occur with central vertigo are motor and sensory impairment or deficits, slurred speech (dysarthria) and uneven gait (ataxia). Central vertigo can be caused by migraines, strokes, tumors, seizures, multiple sclerosis, trauma or infections.
Peripheral vertigo involves lesions affecting the inner ear or the vestibular division of the acoustic nerve. Peripheral vertigo usually is more severe than central vertigo, has no specific timing and is always associated with nystagmus in the horizontal plane. Sometimes hearing loss or ringing of the ears (tinnitus) occurs. Peripheral vertigo is caused by Meniere’s disease, acute vestibular neuronitis or BPPV.
Treatment depends on the source or cause of the vertigo. If a drug is causing the vertigo, then changing medication or altering dosage may help with the vertigo.
A type of physical therapy called vestibular rehabilitation therapy can be used to improve vertigo. The goal is to minimize symptoms, prevent falls and restore balance. The patient performs exercises to retrain the brain to compensate for the cause of the vertigo. The prognosis depends on the age, cognitive function, coordination, motor skills, general health and strength of the patient.
Ear infections can cause vertigo and can be treated by antibiotics. If the ear infections are chronic, tubes can be inserted into the eardrum to drain fluid and prevent bacteria from accumulating in the ear.
Benign paroxysmal positional vertigo can be treated with an oral anti-emetic that can be taken up to three times per day or as needed. This medication can cause drowsiness, blurred vision or dry mouth.
Meniere’s disease can be treated by decreasing sodium in the diet and with diuretics. A short course of corticosteroids can be taken to reduce inflammation and improve hearing. Antibiotics can be applied to the middle ear to treat severe cases of Meniere’s disease.
Vertigo that is caused by migraines will usually go away when the migraine clears. Strokes, tumors and multiple sclerosis require treatment with medication, radiation, surgery and therapy.
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