vertigo
VERTIGO

Vertigo is having a sensation of spinning of either the surrounding or within oneself but physical movement does not exist.

It may be secondary to different causes that may be determined by numerous factors eg timing and duration, aggravating conditions or associated symptoms.
Central vertigo originates from the central nervous system (brainstem or cerebellum). It is uncommon but more serious and should be ruled out immediately.
Peripheral vertigo originates from the labyrinth or vestibular nerve.

Introduction

  • True vertigo is a type of dizziness wherein the patient experiences a false sense of spinning or rotational motion in the surroundings or within oneself even when there is no physical movement
  • May be secondary to different causes that may be determined by numerous factors eg timing and duration, aggravating conditions or associated symptoms

Timing and duration of vertigo

  • Vertigo lasting a few seconds: Acute vestibular neuronitis (late stages), Meniere’s disease (late stages)
  • Several seconds to a few minutes: Benign paroxysmal positional vertigo (BPPV), perilymphatic fistula
  • Several minutes to 1 hour: Posterior transient ischemic attack (TIA), perilymphatic fistula
  • Hours: Meniere’s disease, perilymphatic fistula from trauma or surgery, migraine, acoustic neuroma
  • Days: Early acute vestibular neuronitis, stroke, migraine, multiple sclerosis (MS)
  • Weeks: Psychogenic (vertigo lasts for weeks without improvement)

Provoking or aggravating factors

  • Changes in head position: Acute labyrinthitis, benign paroxysmal vertigo, cerebellopontine angle tumor, multiple sclerosis, perilymphatic fistula, Meniere’s disease, acute vestibular neuronitis
  • Recent upper respiratory viral infection: Acute vestibular neuronitis, acute labyrinthitis
  • Stress: Migraine, psychiatric or psychological causes
  • Immunosuppression: Herpes zoster oticus
  • Changes in ear pressure, trauma, excessive straining, loud noises: Perilymphatic fistula

Signs and Symptoms

Severity of vertigo over time

  • In acute vestibular neuronitis, initial symptoms are typically severe but lesser over the following days
  • In Meniere’s disease, vertigo attacks may occur in clusters at first, but frequency of episodes may decrease over time
  • In psychological causes, vertigo remains constant for several weeks

Associated symptoms occurring with vertigo

  • Feeling of fullness in the ear: Acoustic neuroma, Meniere’s disease
  • Ear or mastoid pain: Acoustic neuroma, acute middle ear disease, herpes zoster oticus
  • Facial weakness: Acoustic neuroma
  • Neurologic findings: Cerebellopontine angle tumor, cerebrovascular disease, multiple sclerosis
  • Headache: Acoustic neuroma, migraine
  • Hearing loss: Meniere’s disease, perilymphatic fistula, acoustic neuroma, transient ischemic attack or stroke involving anterior inferior cerebellar artery, herpes zoster oticus, cholesteatoma, otosclerosis
  • Imbalance: Acute vestibular neuronitis, cerebellopontine angle tumor, Meniere’s disease
  • Tinnitus: Acute labyrinthitis, acoustic neuroma, Meniere’s disease
  • Nausea or vomiting: Acute vestibular neuronitis, benign paroxysmal vertigo, Meniere’s disease, cerebrovascular stroke
    • If neurologic symptoms appear as well, central causes of vertigo should be considered
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