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Vertigo-associated disorders

Peripheral vertigo; Central vertigo; Dizziness

 

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

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

Causes

 

There are two types of vertigo, peripheral and central vertigo.

Peripheral vertigo is due to a problem in 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. This is the nerve between the inner ear and the brain stem.

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 disease
  • Pressure on the vestibular nerve, usually from a noncancerous tumor such as a meningioma or schwannoma

Central vertigo is due to a problem in the brain, usually in the brain stem or the back part of the brain (cerebellum).

Central vertigo may be caused by:

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

Depending on the cause, other symptoms can include:

  • Problem 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 may have other symptoms, including:

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

 

Exams and Tests

 

Examination by the health care provider may show:

  • Problems 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
  • Brain stem 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

 

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

To help resolve symptoms of benign positional vertigo, the provider may perform the Epley maneuver on you. This involves placing your head in different positions to help reset the balance organ.

You may be prescribed medicines to treat symptoms of peripheral vertigo, such as nausea and vomiting.

Physical therapy may help improve balance problems. You'll be taught exercises to restore your sense of balance.

To prevent worsening of symptoms during an episode 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.

 

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. If you have never had vertigo before or if you have vertigo with other symptoms (such as double vision, slurred speech, or incoordination), call 911.

 

 

Open References

References

Chang AK, Olshaker JS. Dizziness and vertigo. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 19.

Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 165.

Furman JK, Mccall AA. Otoneurologic manifestations of otologic and systemic disease. In: Aminoff MJ, ed. Aminoff's Neurology and General Medicine. 5th ed. Philadelphia, PA: Elsevier; 2014:chap 23.

Kerber KA, Baloh RW. Neuro-otology: diagnosis and management of neuro-otoligical disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 37.

 
  • Tympanic membrane

    Tympanic membrane - illustration

    The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When soundwaves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear. The middle ear bones then transfer the vibrating signals to the inner ear. The tympanic membrane is made up of a thin connective tissue membrane covered by skin on the outside and mucosa on the internal surface.

    Tympanic membrane

    illustration

  • Cerebellum - function

    Cerebellum - function - illustration

    The cerebellum processes input from other areas of the brain, spinal cord and sensory receptors to provide precise timing for coordinated, smooth movements of the skeletal muscular system. A stroke affecting the cerebellum may cause dizziness, nausea, balance and coordination problems.

    Cerebellum - function

    illustration

  • Ear anatomy

    Ear anatomy - illustration

    The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.

    Ear anatomy

    illustration

    • Tympanic membrane

      Tympanic membrane - illustration

      The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When soundwaves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear. The middle ear bones then transfer the vibrating signals to the inner ear. The tympanic membrane is made up of a thin connective tissue membrane covered by skin on the outside and mucosa on the internal surface.

      Tympanic membrane

      illustration

    • Cerebellum - function

      Cerebellum - function - illustration

      The cerebellum processes input from other areas of the brain, spinal cord and sensory receptors to provide precise timing for coordinated, smooth movements of the skeletal muscular system. A stroke affecting the cerebellum may cause dizziness, nausea, balance and coordination problems.

      Cerebellum - function

      illustration

    • Ear anatomy

      Ear anatomy - illustration

      The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.

      Ear anatomy

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Vertigo-associated disorders

         
           

          Review Date: 1/5/2016

          Reviewed By: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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