Vertigo

Vertiginous Syndrome, Subjective Vertigo, Objective Vertigo, Pathological Vertigo, Physiological Vertigo, Positional Vertigo

What is Vertigo?

Vertigo is a sensation of rotation in which an individual feels as if his or her surroundings are spinning or moving. Though sometimes inaccurately called "dizziness," it is a unique symptom related to specific disease states of the nervous system (pathologic vertigo) or a mismatch in the body's normal systems of balance and position (physiologic or positional vertigo). Some examples of physiologic vertigo are seasickness, carsickness, and height vertigo.

Acute vertigo is characterized by a sudden attack of vertigo in an individual. It is usually due to an inflammation of the semicircular canals of the inner ear (nonspecific labyrinthitis), possibly of viral origin. Generally, the attack is self-limited.

Chronic vertigo occurs almost daily and is usually indicative of serious disease.

The principal causes of vertigo are Meniere's disease, drugs (gentamicin, anticonvulsant intoxication), toxins (notably alcohol intoxication), vestibular neuronitis, multiple sclerosis, migraine, and benign positional vertigo.

How is it diagnosed?

History: The individual's primary complaint is a sudden sensation that his or her surroundings are spinning or moving (vertigo). Headache, nausea and vomiting, and blurred vision are common if labyrinthitis is the cause.

A careful inquiry about recent drug use (prescription or otherwise) is necessary. A complete history may reveal the likely source of vertigo.

For example, positional vertigo is characterized by sudden, extreme vertigo when the individual lies on one side or the other, or when leaning the head back to look at something above. Unlike other forms of vertigo, it is the position of the head, not the movement, that causes the vertigo. These symptoms usually decrease in less than a minute.

Sudden symptoms of vertigo may occur after flying or after a prolonged drive in the mountains. Symptoms of vertigo may also occur within 24 hours after alcohol intake.

Vertigo may be caused by sudden rupture of a part of the inner ear (round window of the cochlea). When this happens, intense physical exertion, such as calisthenics or scuba diving, has usually preceded the attack.

Physical exam: The general physical exam is usually normal. The nose and throat are examined for evidence of an active or resolving upper respiratory infection. The neurologic exam includes comparing the hearing on both sides, observation for the presence of jerky eye movements (nystagmus), and gait and position (heel to toe walking, touching the nose while the eyes are closed).

Tests for definitive diagnosis of underlying cause of vertigo include audiometry, CT scan, and specific testing of the balancing function of the inner ear (caloric stimulation and electronystagmography).

How is Vertigo treated?

Treatment depends on determining the cause and its elimination. If no neurologic or metabolic defect can be identified, bedrest for two to three days is effective as the principle treatment in most cases. In addition, anti-vertiginous drugs are prescribed.

Positional vertigo is an inconvenience but rarely a serious problem unless the individual's occupation is one in which even short episodes of vertigo may be disruptive. The most common treatment is to avoid positions or activities that cause the symptoms.

Medications

Phenergan (Promethazine), Atarax (Hydroxyzine), Klonopin (Clonazepam), Valium (Diazepam)

What might complicate it?

Complications would depend on the underlying disease responsible for the vertigo.

Predicted outcome

Acute vertigo is usually self-limited. Very little specific treatment is available for individuals with chronic vertigo. In many, change in lifestyle becomes necessary. This is particularly true in individuals with positional vertigo who must learn to avoid the position that precipitates the symptoms.

Alternatives

Other possibilities include acute cerebellar lesions, cerebellopontine angle lesions, partial seizures, brain stem ischemia or infarction, perilymphatic fistula, vertebral basilar artery insufficiency, irritation of destruction of the eighth nerve pathways, tumor, or multiple sclerosis. Vertigo is a symptom that may be present in association with many other conditions.

Appropriate specialists

Neurologist, neurosurgeon, otolaryngologist, ophthalmologist, and internist.

Last updated 23 June 2011


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