Vertigo-associated disorders

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

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

There are two types of vertigo:

• Peripheral vertigo occurs if there is a problem with the part of the inner ear that controls balance (vestibular labyrinth or semicircular canals) or with the vestibular nerve, which connects the inner ear to the brainstem.
• Central vertigo occurs if there is a problem in the brain, particularly in the brainstem or the back part of the brain (cerebellum).

Vertigo related to the inner ear may be caused by:

• Benign positional vertigo (also called benign paroxysmal positional vertigo)
• Drugs called aminoglycoside antibiotics
• Injury (such as head injury)
• Labyrinthitis
• Ménière's disease

Vertigo related to the vestibular nerve may be caused by:

• Inflammation (neuronitis)
• Nerve compression (usually a noncancerous tumor such as a meningioma or schwannoma)

Vertigo related to the brainstem may be caused by:

• Blood vessel disease
• Drugs (anticonvulsants, aspirin, alcohol)
• Migraine
• Multiple sclerosis
• Seizures (rarely)

The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms from the condition causing the vertigo. Symptoms can include:

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

The spinning sensation may cause nausea and vomiting in some people.

A physical exam may reveal:

• Eye movement problems, involuntary eye movements (nystagmus)
• Lack of coordination and balance, difficulty walking
• Hearing loss
• Weakness

Tests to determine the cause of vertigo may include:

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

Medications to treat peripheral vertigo may include:

• Anticholinergics (such as scopolamine)
• Antihistamines (such as meclizine)
• Benzodiazepines (such as diazepam or lorazepam)
• Promethazine (to treat nausea and vomiting)

Benign positional vertigo is most often treated with physical maneuvers that help reposition small structures in the semicircular canals of the inner ear. This reduces or stops the vertigo.

The cause of central vertigo should be identified and treated as appropriate.

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

The outcome depends on the cause.

Persistent, unrelieved vertigo can interfere with driving, work, and lifestyle. It can also cause falls, which can lead to many injuries, including hip fractures.

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

Baloh RW. Hearing and equilibrium. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 454.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, et al., eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005; chap 126.