Vertigo - Causes, symptoms and treatment

Vertigo (Dizziness) – Causes, Symptoms, and Treatment

What is vertigo?

Vertigo is the false sensation of movement or spinning, or the feeling that objects around you are moving. It is often accompanied by:

• Loss of balance

• Nausea and vomiting

• Tinnitus (ringing in the ears)

It is important to distinguish:

• True vertigo – the feeling of spinning or movement; can last seconds, hours, or even days. Lying still sometimes helps.

• False vertigo – caused by weakness, fatigue, low blood pressure, anemia, or anxiety; usually disappears when the person calms down.

Mechanism of vertigo

Balance depends on three senses:

1. Vision

2. Vestibular sense (inner ear) – the most important; the inner ear labyrinth consists of:

   • Cochlea (hearing organ)

   • Vestibule (detects head position)

   • Semicircular canals (detect head movement)

3. Proprioception (body and muscle sense)

These systems send information to the brain to coordinate movement and maintain balance. Disruption in any of these systems can cause vertigo.

Types of vertigo

1. Peripheral vertigo – most common (>90% of cases); caused by inner ear problems; often accompanied by tinnitus and hearing disturbances.

2. Central vertigo – caused by brain disorders (brainstem or cerebellum); less common but requires urgent evaluation.

Causes

Peripheral vertigo:

• Benign paroxysmal positional vertigo (BPPV) – calcium crystals in the inner ear, triggered by sudden head movements

• Vestibular neuritis or labyrinthitis – viral or bacterial infection of inner ear nerves

• Meniere’s disease – fluid buildup in the inner ear

• Post-traumatic vertigo – after a head injury or concussion

• Motion sickness – vertigo caused by moving vehicles, boats, etc.

Central vertigo:

• Brain injury (stroke, hemorrhage, tumor)

• Multiple sclerosis

• Migraine (basilar migraine)

• Narrowing of neck arteries → temporary reduced blood flow to the brain

• Toxins (alcohol, certain medications)

Clinical features

• Sudden vertigo with head movements (turning, tilting back)

• Duration: seconds to hours

• May be accompanied by nausea, vomiting, tinnitus, hearing loss

• Meniere’s disease: ear pressure, hearing loss, lasts minutes to hours

• Circulatory issues: eye movement problems, nausea, mild hearing loss

• Sometimes neck pain and muscle tension

Diagnosis

• Detailed medical history: type of vertigo, activities before onset, injuries, chronic diseases

• Eye examination: abnormal eye movements may indicate inner ear or brain dysfunction

• Balance tests: standing and walking on a straight line, eyes open and closed

• Laboratory tests: anemia, electrolyte imbalances, infections

• Imaging: X-ray of cervical spine, CT, MRI of the brain

• Ultrasound of neck arteries for circulation

• Hearing tests to detect ear disorders affecting balance

Treatment

Goals:

• Relieve acute symptoms

• Treat underlying cause

Symptomatic treatment:

• Hydration (oral or IV)

• Anti-nausea and calming medications

Specific treatment:

• Bacterial infections: antibiotics

• Tumors: surgery, chemotherapy, or radiotherapy

• Meniere’s disease: drugs to reduce inner ear fluid, salt restriction, avoid coffee and strong tea

• Cervical spine disorders: physical therapy

• BPPV: head-positioning exercises (Epley maneuver)

• Chronic vertigo: rehabilitation exercises to improve balance

• Circulatory problems: medications to improve blood flow to brain and inner ear