by Schroeder K

Vertigo

(Dizziness)

Definition

Vertigo is a feeling of spinning or whirling when you are not moving. It can also be an exaggerated feeling of motion when your body is still. Vertigo is a symptom that can be caused by many different conditions. Vertigo is different from passing dizziness or lightheadedness.

Causes

Inner ear nerves and structures sense the position of your head and body in space. Vertigo is often caused by problems with these nerves and structures. Less commonly, it is due to problems in the brain.
Vertigo can be classified as:

Vertigo of Peripheral Origin

Vertigo of peripheral origin is caused by problems of the inner ear. It is the most common type of vertigo. Causes may include:

Vertigo of Central Origin

Vertigo of central origin is not as common as vertigo of peripheral origin, but it is more serious. This type of vertigo is affects the brainstem or the cerebellum, the region of the brain that controls balance. Causes may include:
  • Brain lesion or tumors
  • Stroke
  • Migraine headaches
  • Nervous system disorders such as Parkinson's disease, or multiple sclerosis
  • Epilepsy
  • Excessive exposure to alcohol, heavy industrial metals, or poisons
  • Injury

Risk Factors

Vertigo is a symptom that may be caused by many conditions. Having any of the conditions will make your more prone to having vertigo.

Symptoms

Common vertigo symptoms include:
  • Sensation of rotation
  • Illusion of movement
  • Sensation of feeling pulled in one direction
  • Feeling off-balance
Vertigo is different then lightheadedness. With lightheadedness, there is no sensation of movement. People often feel lightheaded before they faint.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. To find the cause of your vertigo, additional tests may be done. Tests may include:
  • Blood tests
  • Dix-Hallpike maneuver—particular movement of the head to relieve or stimulate symptoms
  • Auditory tests
  • Vision tests
  • Blood pressure test, both lying down and standing up
  • Electronystagmogram (ENG)—to check for nystagmus, an abnormal, rhythmic, jerking eye movement
  • MRI scan
  • Rotatory chair test in certain situations
  • Brainstem auditory evoked potential studies (BAEPS or BAERs)—to check for nerve conduction in the brain auditory nerve and brain stem

Treatment

Vertigo is a symptom of another medical condition. Treatment will focus managing the underlying medical condition. Efforts may also be used to decrease the symptoms of vertigo. These may include one or more of the following:

Medications

  • Antihistamines
  • Benzodiazepines
  • Anticholinergics
  • Anti-nausea medications
In some cases, you may need to stop taking medications that may be causing your vertigo.

Lifestyle Changes

Living with vertigo can be challenging, but not impossible. Try these tips:
If you are in a crowded open space, or out in public:
  • Use a cane to help with balance and mobility
  • Sit at one end of the sports field or theater to avoid moving your head back and forth
  • Bring a stool or chair so you can sit down when you need to
  • Schedule your day around peak times when places are crowded
Other tips:
  • Don't read or work on a computer if you are moving
  • Don't fly if you have sinus or ear problems due to an infection
  • Avoid loud background music and harsh lighting
  • Try to eat smaller meals throughout the day
  • Drink plenty of fluids
  • Avoid tobacco, alcohol, and caffeine

Prevention

There is no known way to prevent vertigo.

RESOURCES

American Academy of Otolaryngology - Head and Neck Surgery http://www.entnet.org

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

CANADIAN RESOURCES

Balance and Dizziness Disorders Society http://www.balanceanddizziness.org

Canadian Academy of Audiology http://www.canadianaudiology.ca

References

Chan Y. Differential diagnosis of dizziness. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):200-203.

Dizziness and vertigo. Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/print/ear%5Fnose%5Fand%5Fthroat%5Fdisorders/approach%5Fto%5Fthe%5Fpatient%5Fwith%5Fear%5Fproblems/dizziness%5Fand%5Fvertigo.html. Updated January 2009. Accessed April 25, 2013.

Dizziness-differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2011. Accessed April 25, 2013.

Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008;14(6):355-364.

Mukherjee A, Chatterjee SK, et al. Vertigo and dizziness-a clinical approach. J Assoc Physicians India. 2003;51:1095-1101.

Strategies for everyday living. Vestibular Disorders Association website. Available at: http://vestibular.org/living-vestibular-disorder/everyday-challenges. Accessed April 25, 2013.

Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005;71(6):1115-1122.

7/2/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Oh HJ, Kim JS, et al. Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology. 2007;68:1219-1222.

9/10/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: University of Texas at Austin School of Nursing, Family Practitioner Program. Evaluation of vertigo in the adult patient. Austin (Tx): University of Texas at Austin, School of Nursing; 2014 May. 19 p. Available at: http://www.guideline.gov/content.aspx?id=48220#Section427. Accessed September 10, 2014.

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