Vertigo-associated disorders

Definition

Vertigo is a false sensation of motion or spinning that leads to dizziness and discomfort.

Vertigo is not the same sensation as light-headedness. People with this condition feel as though they are actually spinning or moving, or that the environment itself is spinning.

Causes, incidence, and risk factors

There are two types of vertigo: peripheral and central. Peripheral vertigo occurs if there is a problem in the vestibular labyrinth (semicircular canals), the portion of the inner ear that controls balance. Central vertigo occurs if there is a an abnormality in the brain, particularly in the brainstem or the cerebellum (back part of the brain).

Disorders associated with peripheral vertigo include the following:

     
  • Benign positional vertigo  
  • Meniere’s disease  
  • Labyrinthitis (sometimes causes vertigo)  
  • Trauma

Disorders associated with central vertigo include the following:

     
  • Stroke (most common)  
  • Multiple sclerosis  
  • Tumor  
  • Infection (abscess)  
  • Inflammatory conditions  
  • Neurodegenerative illnesses that affect the brain stem or cerebellum

Symptoms

The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms associated with the condition that is causing the vertigo. Associated symptoms include the following:

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

Signs and tests

Nystagmus (involuntary eye movements) and hearing loss may be present in both central and peripheral vertigo. Other signs such as other eye movement abnormalities, lack of coordination, weakness, or sensory loss suggest a central cause.

Test to determine the cause of vertigo may include the following:

     
  • Head CT  
  • MRI scan of head and MRA scan of blood vessels of the brain  
  • Caloric stimulation (tests eye reflexes)  
  • Electronystagmography  
  • EEG, evoked auditory potential studies  
  • Lumbar puncture  
  • Blood tests

Treatment

Medications such as antihistamines, anticholinergics, and benzodiazepines may be prescribed to reduce symptoms of peripheral vertigo. Certain exercises may also be helpful.

To treat central vertigo, the underlying cause must be identified and then treated.

Try to avoid head positions that cause vertigo. Use caution in situations such as driving or operating heavy equipment, where even short episodes of vertigo may be dangerous.

Expectations (prognosis)
The outcome depends on the cause.

Complications
Persistent, unrelieved vertigo can interfere with driving, work, and lifestyle. It can also cause falls which can in turn lead to hip fractures.

Calling your health care provider
Call for an appointment with your health care provider if vertigo is persistent or troublesome.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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