Definition

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

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

Causes

     Vertigo related to the inner ear may be caused by:

• Benign positional vertigo (recurrent attacks of vertigo, especially when the head is in certain positions)

• Drugs called aminoglycoside antibiotics

• Ménière's disease

• Labyrinthitis

• Injury

     Vertigo related to the vestibular nerve may be caused by:

• Inflammation (neuronitis)

• Nerve compression (usually a benign tumor such as a meningioma or schwannoma)

     Vertigo related to the brainstem may be caused by:

• Multiple sclerosis

• Blood vessel disease

• Migraine

• Drugs (anticonvulsants, aspirin, alcohol)

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

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

Screening and Diagnostics

     A physical exam may reveal eye movement problems, lack of coordination and balance, weakness, or sensory loss. These signs may suggest a central cause.

     Nystagmus (involuntary eye movements) and hearing loss may be present in both central and peripheral vertigo.

     Tests to determine the cause of vertigo may include:

• 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 to treat peripheral vertigo may include:

• Antihistamines (such as meclizine)

• Anticholinergics

• Benzodiazepines

• Promethazine (to treat nausea and vomiting)

     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.

Complications

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