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Vertigo-associated disorders

Definition

Vertigo is a sensation of motion or spinning that is often described as dizziness.

Vertigo is not the same as light-headedness. People with vertigo feel as though they are actually spinning or moving, or that the world is spinning around them.

Alternative Names

Peripheral vertigo; Central vertigo

Causes

There are two types of vertigo:

• Peripheral vertigo: The problem is due to the part of the inner ear that controls balance. These areas are called the vestibular labyrinth or semicircular canals. The problem may also involve the vestibular nerve, which connects the inner ear to the brainstem.
• Central vertigo: This type is due to a problem in the brain, usually in the brainstem or the back part of the brain (cerebellum).

Peripheral vertigo may be caused by:

• Benign positional vertigo (benign paroxysmal positional vertigo)
• Certain medicines such as aminoglycoside antibiotics, cisplatin, diuretics, or salicylates
• Injury (such as head injury)
• Inflammation of the vestibular nerve (neuronitis)
• Labyrinthitis
• Meniere's disease
• Pressure on the vestibular nerve, usually from a noncancerous tumor such as a meningioma or schwannoma)

Central vertigo may be caused by:

• Blood vessel disease
• Certain drugs such as anticonvulsants, aspirin, and alcohol
• Migraine
• Multiple sclerosis
• Seizures (rarely)
• Stroke
• Tumors (usually noncancerous)

Symptoms

The main symptom is a sensation that you or the room is moving or spinning. The spinning sensation may cause nausea and vomiting.

Other symptoms can include:

• Difficulty focusing the eyes
• Dizziness
• Hearing loss in one ear
• Loss of balance (may cause falls)
• Ringing in the ears

If you have vertigo due to problems in the brain (central vertigo), you will usually other symptoms, including:

• Difficulty swallowing
• Double vision
• Eye movement problems
• Facial paralysis
• Slurred speech
• Weakness of the limbs

Exams and Tests

The doctor or nurse will examine you. This may show:

• Difficulty walking due to loss of balance
• Eye movement problems or involuntary eye movements (nystagmus)
• Hearing loss
• Lack of coordination and balance
• Weakness

Tests that may be done include:

• Blood tests
• Brainstem auditory evoked potential studies
• Caloric stimulation
• Electroencephalogram (EEG)
• Electronystagmography
• Head CT
• Lumbar puncture
• MRI scan of head and MRA scan of blood vessels of the brain

Treatment

Medications to treat peripheral vertigo may include:

• Anticholinergics (such as scopolamine)
• Antihistamines (such as meclizine or dimenhydrinate)
• Benzodiazepines (such as diazepam or lorazepam)
• Promethazine (to treat nausea and vomiting)

The cause of any brain disorder causing vertigo should be identified and treated when possible.

Persistent balance problems may improve with physical therapy. To prevent worsening of symptoms during episodes of vertigo, try the following:

• Keep still. Sit or lie down when symptoms occur.
• Gradually resume activity.
• Avoid sudden position changes.
• Do not try to read when symptoms occur.
• Avoid bright lights.

You may need help walking when symptoms occur. Avoid hazardous activities such as driving, operating heavy machinery, and climbing until 1 week after symptoms have disappeared.

Other treatment depends on the cause of the vertigo. Surgery may be suggested in some cases. 

Outlook (Prognosis)

The outcome depends on the cause.

Possible Complications

Vertigo can interfere with driving, work, and lifestyle. It can also cause falls, which can lead to many injuries, including hip fractures.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have vertigo that does not go away or interferes with your daily activities.

References

Baloh RW, Jen J. Hearing and equilibrium.In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 436.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund VJ, et al., eds. CummingsOtolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 126.

Kerber KO, Baloh RW. Dizziness, vertigo, and hearing loss: Vascular malformations. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth Heinemann Elsevier; 2008:chap 18.

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