Vertigo is an illusion of movement when there is no actual movement. It may occur due to several disorders of the balance system.
Vertigo may vary in type and intensity; common presentations are dizziness, light headedness, sensations of spinning, falling, or rocking, Vertigo may be accompanied with nausea, vomiting, sweating, paleness, headache, blurred vision, hearing loss, tinnitus, fullness of the ear, double vision, reading difficulty, unconsciousness , anxiety, loss of strength depending on the severity and cause of vertigo.
Our balance system is composed of inner ear, eyes, spinal cord, brain stem, cerebellum, and muscles. These systems are related to each other by a complex neural network.
Causes of vertigo
Vertigo most commonly occurs due to inner ear disorders. Disorders of the brain, cerebellum, eyes, heart and blood circulation, migraine, diabetes, anemia, elevated cholesterol and triglyceride are other potential causes of vertigo. It can also be psychological.
Frequent causes of vertigo are:
- Benign paroxysmal positional vertigo (BPPV) : Microscopic crystals within the inner ear cause severe vertigo, triggered by changes of head and body position. Vertigo lasts less than one minute, unless the head remains stationary.
- Meniere’s disease: dizzy spells are associated with pressure in the ear. hearing loss and tinnitus, due to increased inner ear fluid called endolymph.
- Migraine associated vertigo: dizzy episodes are accompanied with headaches, photophobia and sonophobia.
- Vestibular neuritis: sudden unset of severe vertigo and balance disorder lasts for several weeks, caused by viruses which attack the vestibular nerve.
- Phobic postural vertigo: dizziness and imbalance that occurs as a result of attempts to keep balance under control.
- Circulation problems of the brainstem
- Parkinson’s disease
- Multiple sclerosis
- Perilymph fistula
- Tumors of the brain, cerebellum, and temporal bone
- Heart diseases
- Drug-induced dizziness
- Dizziness due to eye disorders
Evaluation of the patient with vertigo
The most frequent causes of vertigo are related with ear problems, therefore, patients with vertigo may initially visit an ENT specialist. When necessary a neurologist, ophtalmologist and internal disease specialist will also evaluate the patient.
In order to find out the cause of dizziness, a detailed questionnaire, examination of balance systems, hearing and balance function tests, CT scan, magnetic resonance imaging (MRI), and blood tests may be required.
Treatment
Since vertigo is not a disease alone, there is no specific treatment that can be defined as “vertigo treatment”. Vertigo is corrected by treating the disease causing it:
- BPPV: Loose microscopic crystals are repositioned using maneuvers. These maneuvers are initiated with the physician and continued by the patient at home.
- Meniere’s disease : There is no cure for Meniere’s disease. Drugs are used to stop or slow the progression of this disease. Injections from the eardrum and occassionally surgery may be required.
- Migraine associated vertigo: Treated with medications
- Vestibular neuritis: Treated with medications and balance exercises.
- Phobic postural vertigo: Treated with medications and balance exercises.
- Circulation problems of the brainstem: Treated with medications to relieve blockage and prevent recurrence.
- Perilymph fistula: Surgically closed.
- Tumors: Surgically removed.
An example of repositioning maneuver applied for BPPV:
Examples of vestibular rehabilitation exercises:
