Vertigo

Vertigo is a symptom and not a disease. It means the inappropriate sensation or illusion of motion in a patient who is actually not moving as perceived.

Vertigo movieThe word originates from the Latin word “vertō” which means “ a whirling or spinning movement”. Some also considers an inappropriate sensation of linear motion as vertigo. It is not a pleasant sensation. It is often accompanied by other symptoms including nausea, vomiting, poor balance, falling, palpitations, hyperventilation, anxiety, sweating, urination and even diarrhea.

It can be subjective (motion of patient self) or objective (motion of environment). It can also be divided in peripheral (inner ear and nerve) and central (brainstem and connections). Peripheral disorders are often accompanied by ear symptoms such as hearing loss, tinnitus and pressure. When originating from the brain neurological symptoms such as weakness, loss of sensation, double vision, headache, convulsions, swallowing difficulty, speech impairment and facial nerve weakness may all be present. It may occur in isolation with cerebellar disorders.

Common peripheral conditions, include benign paroxysmal positional vertigo (BPPV), Meniere’s disease (MD), vestibular neuritis, vestibular paroxysmia, perilymph fistula and vestibular scwannoma. Vestibular migraine (MAV), multiple sclerosis (MS), stroke, encephalitis and epilepsy are some of the central conditions that can present with vertigo.

Patients should be examined to differentiate between peripheral or central conditions. When of central origin it may be accompanied by other neurological findings and when peripheral by ear findings.

When associated with nystagmus (abnormal reflexive repetitive jerking eye movements) it can be considered vestibular of origin. The characteristics and type of the nystagmus may help to distinguish between peripheral and central disorders. It is advised that all new cases should get a MRI to exclude central pathology.

Acute vertigo is usually treated symptomatic with medication and seldom with maneuvers. Causative conditions can be treated to prevent it, either with medication or with surgery.