Vertigo is a subjective symptom in which an individual has a perceived sensation of movement when there is no movement, usually it is of a turning or spinning quality. A common description for this in English is “dizziness” but spinning, tilting, rotating, or rocking are common alternatives. In some individuals, the sensation appears to be based on the axis of their body, and in others it appears to be that the environment is moving. This is often described as, “I am spinning”, or “the room is spinning”. The main anatomic generators of normal equilibrium include the fluid filled inner ear chambers (semicircular canals & labyrinths) and the vestibular nerve that connects those components to the stalk of the brain (brainstem).
Diseases of the vestibular nerve or inner ear are considered “peripheral." Disorders of the brainstem are considered “central”. The brainstem integrates signals from both ears to establish equilibrium or orientation of the body to space and gravity. Because of the structures involved, attempts to identify the most likely source of the vertigo is essential so that a direct therapy might offer a more permanent resolution.
Nonspecific dizziness can be the side effect of medication or excessively low blood pressure or blood sugar. High velocity movements such as amusement park rides or a traumatic blow to the head, can induce position sensitive vertigo. Usually, vertigo induced by rapid position changes or head movement is the result of inner ear fluid or hair cell disturbance. Whereas vertigo associated with blurred or double vision is associated with brainstem disease and may be a forewarning of a stroke. Vertigo with progressive hearing loss may reflect nerve damage caused by a benign tumor type (Schwannoma). A thorough diagnostic workup could include MRI testing with selective slices through the inner ear components and brainstem to help identify a specific cause and to exclude several serious disorders. Auditory evoked potentials (AEP) and vestibular nystagmography (VNG) or eye movements testing can identify several other physiologic types of lesions and help in directing therapy.
Seeking prompt medical attention should limit risk and initiate prompt therapy.
Ménière's disease is a neurodegenerative disorder in which attacks of vertigo are experienced but also associated at some point with progressive hearing loss, aberrant sounds, tinnitus, and feelings of fullness or pressure in the ear.
Posttraumatic causes of vertigo can result from inner ear disruption, vestibular nerve injury, or brainstem dysfunction. The critical part of approaching a disorder associated with vertigo is to confidently exclude serious underlying causes. Medications known as vestibular suppressants may alleviate symptoms and include Dramamine, Meclizine, or transdermal Scopolamine.
If BPPV is a strong consideration, vestibular rehabilitation with Epley maneuvers can enhance balance and reduce or eliminate the vertigo feeling.
Rarely, surgical intervention may be considered if endolymphatic leakage or a tumor is identified.
The full battery of these services is available at MNA & PC
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