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Vertigo

Vertigo

Vertigo is an abnormal sensation that is described by the person as a feeling they are spinning or that the world is spinning around them. It is most often associated with an inner ear problem.

 

The inner ear has two parts, the semicircular canals and the vestibule, that helps the body know where it is in relationship to gravity. There are three semicircular canals that are aligned at right angles to each other and act as the gyroscope for the body.

 

The canals are filled with fluid and are lined with a nerve filled, crystal encrusted membrane that transmits information to the cerebellum, the part of the brain that deals with balance and coordination. The cerebellum adds information from sight and from nerve endings in muscles that deal with proprioception, the perception of movement, to help the brain know where it is in relationship to gravity and the world.

 

Normally, when the head moves, fluid in the semicircular canals shifts and that information is relayed to the brain. When the head stops moving, the fluid stops as well. There may be a slight delay and is the basis for the vertigo experienced after people participate in many children's games and carnival rides.

 

When a person goes on a merry-go-round or spins quickly around in circles, the fluid in the canals develops momentum and even though the head stops spinning, the fluid may continue to move. This causes vertigo or a spinning sensation and may cause the person to fall or stumble in a crooked line. It also may be associated with vomiting.

 

In patients with vertigo, inflammation of the fluid or irritation of the crystals on the nerve membrane that lines the walls of the semicircular canals may cause the spinning sensation even without much head movement. Often, only one canal is involved and the person may be symptom free if they don't move.

Symptoms

Vertigo implies that there is a sensation of motion either of the person or the environment, often perceived as if the room is spinning around you. This should not be confused with symptoms of lightheadedness or fainting. Vertigo differs from motion sickness in that motion sickness is a feeling of being off-balance and lacking equilibrium, caused by repeated motions such as riding in a car or boat.

 

  • If true vertigo exists, symptoms include a sensation of disorientation or motion. In addition, the individual may also have any or all of these symptoms: 
  1. nausea or vomiting,
  2. sweating,
  3. abnormal eye movements.
  • The duration of symptoms can be from minutes to hours, and symptoms can be constant or episodic. The onset may be due to a movement or change in position. It is important to tell the doctor about any recent head trauma or whiplash injury as well as any new medications the affected individual is taking. 
  • The person may have hearing loss and a ringing sensation in the ears. 
  • The person might have visual disturbances, weakness, difficulty speaking, a decreased level of consciousness, and difficulty walking.

Causes

Vertigo can be caused by problems in the brain or the inner ear. 

 

  • Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction. This type of vertigo is rarely serious and can be treated. 
  • Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular neuritis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. The most common cause of labyrinthitis is a viral or bacterialinner ear infection. 
  • Meniere's disease is composed of a triad of symptoms including: episodes of vertigo, ringing in the ears (tinnitis), and hearing loss. People with this condition have the abrupt onset of severe vertigo, fluctuating hearing loss, as well as periods in which they are symptom-free. 
  • Acoustic neuroma is a type of tumor of the nerve tissue that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss. 
  • Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed. The result is that the person's eyes gaze away from the side with the problem. Walking is also extremely impaired. 
  • Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose. 
  • Head trauma and neck injury may also result in vertigo, which usually goes away on its own. 
  • Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache. There is often a prior history of similar episodes but no lasting problems.
  • Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can lead to lowered blood flow to the brain, causing vertigo symptoms.

Treatment

While some vertigo is self limited and may be treated with medications, vertigo from BPPV or labyrinthitis is often treated with physical therapy. Using Epley maneuvers, the head is taken through a variety of positions and manipulated to clear debris (crystals) from the semicircular canals and to reduce the inflammation that the debris causes.

 

Medications like diazepam (Valium) and meclizine (Antivert) are used to decrease inflammation within the vestibular system.

 

Some patients are placed in a soft collar to limit range of motion of their heads while the vertigo gradually resolves.

 

If there is concern that there is a viral infection causing the labyrinthitis or neuritis, antiviral medications like acyclovir (Zovirax) or valacyclovir (Valtrex) may be considered.

 

Patients with acoustic neuroma or other structural problems of the ear may require surgery.

 

Patients with central causes of vertigo need further investigation and treatment will be tailored to their specific underlying diagnosis.

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