Introduction to vertigo
Vertigo is the most common type of dizziness (light-headedness or faintness or unsteadiness). It is the false sensation of motion, usually rotational motion, either oneself or surrounding.1 It occurs as a result of a disturbance in the balance mechanism in the body or vestibular system. The vestibular system consists of structures of the inner ear, the vestibular nerve, brainstem, and cerebellum. These structures are responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves.2
When head moves, an apparatus in the inner ear known as labyrinth transmits signals of movement to the vestibular nerve and the vestibular nerve carries the information to the brainstem and cerebellum, which is responsible for controlling balance, posture, and motor coordination.
Signs and Symptoms of vertigo
People with vertigo have an unusual and uncomfortable sense that they, their environment, or both are spinning around. The sensation of movement is called subjective vertigo and the perception of the movement in surrounding objects is called objective vertigo.
Some patients describe a feeling of being pulled toward the floor or toward one side of the room. Moving the head, changing position, and turning while lying down often worsen vertigo. Nausea and vomiting and involuntary eye movements (nystagmus) are commonly associated with this condition.1
Incidence and Prevalence of vertigo
Vertigo is one of the most common health problems in adults affecting approximately 20–30% of the general population. Prevalence of vertigo is slightly higher in women and it is almost three times more frequent in the elderly than in young people.3
Causes of vertigo
Vertigo can be caused by disorders in the inner ear (peripheral vestibular system) or vestibular nerve, brain stem, and cerebellum (central vestibular system). Among the inner ear disorders, vertigo most commonly results from motion sickness. An abnormal collection of calcium particles in the inner ear known as benign paroxysmal positional vertigo, or BPPV, Meniere’s disease, and disorders of the vestibulocochlear nerve can cause vertigo. Other disorders of the inner ear or its nerve connections responsible for vertigo include bacterial infections and tumors of the nerve such as auditory nerve tumors. Certain drugs such as antibiotics, anticancer, antiepileptic and antipsychotic drugs can damage inner ear.1–4
A decrease in the blood supply to the brain stem and cerebellum can cause vertigo. Other less common disorders associated with vertigo are multiple sclerosis, fractures at the base of the skull, head injuries, seizures, infections, and tumors growing in or near the base of the brain. Vertigo can sometimes be part of a migraine attack and occasionally occurs without a headache. Occasionally, vertigo is caused by disorders that suddenly increase pressure within the skull, putting pressure on the brain. These disorders include benign intracranial hypertension, brain tumors and bleeding within the skull.1
Diagnosis and Treatment of vertigo
It is important to diagnose the cause of vertigo as quickly as possible to rule out serious conditions such as cardiovascular disease, stroke, hemorrhage or tumor. Diagnosis includes clinical history, physical and neurological examination, blood tests and imaging tests.
Treatment depends on identifying and eliminating the underlying cause, for example, if there is motion sickness, than the situations that might cause it should be avoided. In some cases a particular medication causes the condition, the medicine may be given in lower dosage or discontinued to relieve the symptoms of vertigo. The underlying cause of vertigo should be treated with appropriate medication, such as antibiotics in ear infection can be used.
Vestibular rehabilitation therapy (VRT): it is a type of physical therapy has been found to be useful in the treatment of vertigo. In VRT, the patient is asked to perform such exercises that are designed to help the brain to adapt and compensate for the mechanism which is causing vertigo.
- Hanley K, O’ Dowd T. Symptoms of vertigo in general practice: A prospective study of diagnosis. Br J Gen Pract. 2002; 52: 809–812.
- Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005; 71: 1115–1122.
- Neuhauser HK. Epidemiology of vertigo. Curr Opin Neurol. 2007 20(1): 40–46.
- Baloh, RW. Vertigo. Lancet. 1998; 352: 1841–1846