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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.

Alternative Names

Peripheral vertigo; Central vertigo

Causes

There are two types of vertigo, peripheral and central vertigo.

Peripheral vertigo is due to a problem in the part of the inner ear that controls balance. These areas are called the vestibular labyrinth or semicircular canals. The problem may also involve the vestibular nerve, which connects the inner ear to the brain stem.

Peripheral vertigo may be caused by:

  • Benign positional vertigo (benign paroxysmal positional vertigo)
  • Certain medicines such as aminoglycoside antibiotics, cisplatin, diuretics, or salicylates
  • Injury (such as head injury)
  • Inflammation of the vestibular nerve (neuronitis)
  • Labyrinthitis
  • Meniere's disease
  • Pressure on the vestibular nerve, usually from a noncancerous tumor such as a meningioma or schwannoma

Central vertigo is due to a problem in the brain, usually in the brain stem or the back part of the brain (cerebellum).

Central vertigo may be caused by:

  • Blood vessel disease
  • Certain drugs such as anticonvulsants, aspirin, and alcohol
  • Migraine
  • Multiple sclerosis
  • Seizures (rarely)
  • Stroke
  • Tumors (cancerous or noncancerous)

Symptoms

The main symptom is a sensation that you or the room is moving or spinning. The spinning sensation may cause nausea and vomiting.

Other symptoms can include:

  • Difficulty focusing the eyes
  • Dizziness
  • Hearing loss in one ear
  • Loss of balance (may cause falls)
  • Ringing in the ears

If you have vertigo due to problems in the brain (central vertigo), you may have other symptoms, including:

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

Exams and Tests

Examination by the doctor may show:

  • Difficulty walking due to loss of balance
  • Eye movement problems or involuntary eye movements (nystagmus )
  • Hearing loss
  • Lack of coordination and balance
  • Weakness

Tests that may be done include:

Treatment

The cause of any brain disorder causing vertigo should be identified and treated when possible.

To help resolve your symptoms, the health care provider may perform the Epley maneuver on you. This involves placing your head in different positions to help reset the balance organ.

You may be prescribed medicines to treat symptoms of peripheral vertigo, such as nausea and vomiting.

Physical therapy may help improve balance problems.

To prevent worsening of symptoms during an episode of vertigo, try the following:

  • Keep still. Sit or lie down when symptoms occur.
  • Gradually resume activity.
  • Avoid sudden position changes.
  • Do not try to read when symptoms occur.
  • Avoid bright lights.

You may need help walking when symptoms occur. Avoid hazardous activities such as driving, operating heavy machinery, and climbing until 1 week after symptoms have disappeared.

Other treatment depends on the cause of the vertigo. Surgery may be suggested in some cases.

Possible Complications

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

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have vertigo that does not go away or interferes with your daily activities. If you have never had vertigo before or if you have vertigo with other symptoms (such as double vision, slurred speech, or incoordination), call 911.

References

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 126.

Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: Therapies for benign parocysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:2067-2074.

Kerber KA, Baloh RW. Neuro-otology: diagnosis and management of neuro-otoligical disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 37.

Updated: 10/29/2013

Joseph V. Campellone, M.D., Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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