Vertigo

 

Vertigo is dizziness characterized by a feeling of things moving or spinning around you. Attacks of vertigo may occur intermittently and may last from a few seconds to a few hours. They usually begin with the movement of the head.

 

 

Vertigo occurs when there is a mismatch between the signals being sent to the brain by the eyes and the vestibular system, part of the inner ear that provides information about motion and equilibrium to the brain. These contradictory signals may occur due to problems in the vestibular system or the brain.

Vertigo occurs when there is a problem in the:

1. Inner ear (peripheral vertigo) -- symptoms are usually severe. They start suddenly and last for a short duration.

2. Brain (central vertigo) -- symptoms are relatively mild. They start slowly and last longer.

Causes of peripheral vertigo include:

1. Benign paroxysmal positional vertigo (BPPV) -- displacement of calcium carbonate crystals from utricle to semicircular canals of the inner ear.

2. Vestibular neuritis or labyrinthitis -- inflammation of any of the nerves connecting inner ear to the brain.

3. Meniere’s disease -- excessive fluid in the inner ear. It is accompanied with hearing loss.

4. Perilymphatic fistula -- abnormal opening between inner and middle ear.

5. Acute otitis media -- infection and inflammation of the middle ear.

6. Acoustic neuroma -- a tumor on the nerve that connects the inner ear and brain.

7. Labyrinthine concussion – injury to the labyrinth

8. Motion sickness

9. Foreign body in ear canal

Causes of central vertigo include:

1. Vertebral-basilar artery insufficiency -- decreased blood flow to the back of the brain

2. Cerebellar hemorrhage or infarction -- bleeding in the brain

3. Migraine

4. Tumor

5. Multiple sclerosis

6. Infection

7. Injury to the head

8. Stroke

In older people, interrupted blood supply to the brain can cause vertigo. Brain tumor and certain nerve diseases are rare causes of this condition.

 

 

Symptoms of vertigo include:

1. Feeling of things moving or spinning

2. Nausea

3. Vomiting

4. Sweating

5. Headache

6. Loss of control of body movements (ataxia)

7. Imbalance

8. Discomfort or pain in the eyes due to exposure to light

9. Discomfort due to loud noise

Depending on the cause, there may be different symptoms of vertigo. The following symptoms may also occur:

1. Fullness in ear

2. Hearing loss

3. Vision loss

4. Lack of coordination

 

 

The doctor will take a detailed history and perform some physical tests. These can help in diagnosing the cause of vertigo.

Hearing tests are performed as the first step of investigations. There may be abnormal eye movements if there is a fluid imbalance in the inner ear. Symptoms will worsen with a change in position if the person has positional vertigo.

Laboratory tests are not helpful for diagnosis of vertigo. An electrocardiogram may rule out heart diseases.

The following tests are done to look for brain tumors and stroke:

1. Magnetic resonance imaging (MRI)

2. Computerized tomography (CT)

3. Magnetic resonance angiography (MRA)

 

 

Treatment for vertigo includes physical therapy that moves the head in a specific way:

1. Epley maneuver is a kind of exercise to treat vertigo. It involves rotating the head in a particular way and holding it in each position for 30 seconds. This is repeated until vertigo resolves.

2. Barbecue roll is another maneuver that helps treat vertigo.

3. Medications for vertigo are usually given to control nausea and vomiting. Some of these include:

a) Promethazine

b) Droperidol

c) Benzodiazepine

d) Ondansetron - given intravenously

e) Prochlorperazine - given intravenously

f) Metoclopramide - given intravenously

g) Scopolamine - given as a skin patch

Surgery may be required in some cases of vertigo. 

 

 

Vertigo can result in falls and serious injuries. It is advisable to avoid sitting and lying down until the symptoms resolve. Driving and working with heavy machines should be avoided during a vertigo attack.

Consult a doctor if you have

1. Recurrent vertigo attacks

2. Double vision

3. Hearing loss

4. Speech problems

 

 

Most of the vertigo cases are caused by peripheral causes. In very few cases, vertigo can occur due to serious health conditions. Tests should be done to look for possible causes of vertigo.

Prompt treatment can improve symptoms. The head should be held in a comfortable position to prevent further attacks.

Follow these tips to reduce the severity of symptoms:

1. Do not move during a vertigo attack

2. Avoid moving suddenly

3. Avoid loud sound and bright lights

 

 

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 156.

Chang AK. Dizziness and vertigo. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 16: