Vertigo

(Dizziness)

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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

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Definition

Vertigo is a feeling of spinning or whirling when you are not moving. Or it can be an exaggerated feeling of motion without moving your body. It is the most common form of dizziness, but is different from lightheadedness (the feeling of nearly passing out).

Causes

Vertigo is usually caused by problems in the nerves and structures of the inner ear, called the vestibular system. This system senses the position of your head and body in space as they move.

Vertigo can occur with the following conditions:

Benign Paroxysmal Positional Vertigo (BPPV) –tiny particles collect in the canals of the inner ear and push ear fluid against hair-like sensors in the ear. BPPV may result from:

• Head injury
• Viral infection
• Disorders of the inner ear
• Age-related breakdown of the vestibular system

Labyrinthitis –inflammation of the inner ear. This often follows an upper respiratory infection. It usually occurs together with hearing loss and tinnitus (ringing or buzzing sound).

Vestibular Neuritis –similar to labyrinthitis, but without hearing loss. The cause is unknown.

Meniere's Disease –a condition resulting from fluid buildup in the part of the inner ear called the labyrinth. This usually occurs along with hearing loss and tinnitus.

Acoustic Neuroma –slow-growing, noncancerous tumor of the acoustic nerve that can press on the structures of the inner ear. This condition often occurs with hearing loss.

Vertebrobasilar Insufficiency –diminished blood flow to the base of the brain often caused by atherosclerosis (deposits of fat in the arteries). It is usually related to other neurologic symptoms.

Medications and Other Substances – such as:

• Aspirin
• Streptomycin
• Gentamicin
• Caffeine
• Alcohol
• Anticonvulsants
• Antihypertensives
• Tranquilizers

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Head injury
• Viral upper respiratory infection
• Cerebrovascular disease - deposits of fat in blood vessels leading to the brain

Symptoms

Most cases of vertigo occur with nystagmus, an abnormal, rhythmic, jerking eye movement. Other symptoms depend on the condition causing the vertigo.

BPPV - symptoms may last only a few seconds, but may come and go for weeks or even years.

• Sudden, short (15-30 seconds), intense bursts of dizziness when you move your head a certain way, roll over in bed, or tip your head back to look up. Symptoms do not occur when the head is held still.
• Feeling like the room is spinning
• Lightheadedness
• Imbalance
• Nausea and/or vomiting
• Lingering fatigue

Viral Labyrinthitis -

• Sudden, intense vertigo, lasting for several days to one week and often occurring with nausea and vomiting
• Hearing loss and tinnitus in one ear possible

Vestibular Neuritis - similar to viral labyrinthitis, but no hearing loss

Meniere's Disease - sudden vertigo attacks lasting between minutes and hours and typically occurring with prominent hearing loss and tinnitus

Vertebrobasilar Insufficiency -

• True vertigo
• Visual disturbances
• Difficulty speaking
• Disorientation
• Incoordination

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, the following tests may be performed:

• Vestibular maneuvers auditory tests
• Blood pressure test, both lying down and standing up
• ENG (electronystagmogram) – to check for nystagmus
• MRI (magnetic resonance imaging) – to look for problems in the brain, such as a stroke or brain tumor
• Rotatory chair test (for difficult cases)
• Auditory evoked potential studies – to check for nerve conduction in the brain auditory nerve and brain stem (severe or persistent cases)

Treatment

Vertigo due to BPPV, labyrinthitis, or vestibular neuritis may subside on its own, within six months of onset.

Treatments include:

Medications

To treat vertigo and nausea:

• Meclizine (Antivert, Bonine, Dramamine, Meclicot, Medivert)
• Dimenhydrinate (Calm X, Dinate, Dramamine, Dramanate, Hydrate, Triptone)
• Promethazine (Anergan, Antinaus, Pentazine, Phenazine, Phencen, Phenergan, Phenerzine, Phenoject, Pro-50, Promacot, Pro-Med 50, Promet, Prorex, Prothazine, Shogan, V-Gan)
• Scopolamine (Transderm-Scop)
• Atropine
• Diazepam (Diastat, Diazepam Intensol, Dizac, Valium)

To treat Meniere's disease:

• Low-salt diet
• Diuretics
• Sedatives
• Antihistamines
• Antibiotics injected into the middle ear

Maneuvers

Most often used to treat BPPV:

Semont maneuver – rapidly moving the patient from lying on one side to the other (also called liberatory maneuver)

Epley maneuver – head exercises to move the loose particles to a place in the ear where they won't cause dizziness (also called modified liberatory maneuver)

If you continue to experience vertigo, the maneuvers can be repeated, or more difficult maneuvers called Brandt-Daroff exercises can be done.

Surgery

If symptoms persist for a year or more, and cannot be controlled by the maneuvers, a surgical procedure called "canal plugging" may be recommended. Canal plugging completely stops the posterior canal's function without affecting the functions of the other canals or parts of the ear. This procedure poses a small risk to hearing. Other surgical procedures include removing parts of the vestibular nerve or semicircular canals in the inner ear.

Treatment of the underlying cause

Vertigo can be a symptom of another medical condition. Once that condition is treated, vertigo should stop.

Prevention

If you are prone to vertigo, the following precautions may help prevent an episode:

• Rest your head on two or more pillows while sleeping.
• Avoid sleeping on the "bad side."
• In the morning, get up slowly and sit on the edge of the bed for a minute before standing.
• Avoid bending down to pick items up.
• Avoid extending your neck, such as to get something out of a cabinet.
• Be careful at the dentist's office, hair salon, or in sports activities or positions where your head is flat or extended.

Organizations

Vestibular Disorders Association
http://www.vestibular.org/

Sources:

American Academy of Family Physicians

Vestibular Disorders Association

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Last reviewed June 2001 by Medical Review Board