Derived from the Latin words, ‘vertere’ meaning ‘to turn’ and ‘igo’ meaning ‘condition’, vertigo is the faulty perception of the body, in relation to space. The surroundings seem to spin in rotational motion, while the body remains stationary. These episodes of dizziness may last for few seconds or continue for days.
Causes of Vertigo
The impact dislodges the debris in the inner ear. This free-floating debris induces false movement signals in the brain.
Antidepressants, sedatives, hypertensive drugs and anticonvulsants may trigger spells of dizziness.
In certain cases, the exact reasons are unknown.
- Inner ear issues
- Benign paroxysmal positional vertigo (BPPV) - Sudden changes in the head position cause displacement of calcium carbonate crystals in the inner ear (otoliths). This sends incorrect signals to the brain.
- Labyrinthitis - Inflammation of the fluid-filled channels (labyrinths) of the inner ear may trigger vertigo.
- Meniere’s disease - Fluid accumulation in the inner ear generates a change in ear pressure, causing dizzy spells.
- Vestibular neuritis - Inflammation of the vestibular nerve causes improper passage of sensory information to the brain, leading to vertigo.
- Cholesteatoma - Non-malignant cysts of epithelium erode bones behind the eardrum and cause vertigo.
- Head or neck injury
- Medication
- Idiopathic
Signs Or Symptoms of Vertigo
- Feeling unsteady
- Sensation of rotation
- Nausea
- Vomiting
- Motion sickness
- Constant headache
- Ringing sensation in the ear (tinnitus)
- Repetitive, uncontrolled eye movements (nystagmus)
- Feeling of stuffiness within the ear
Typical Tests
A thorough physical examination is done, wherein the physician asks detailed questions regarding the episodes and symptoms. A posturography test is conducted. Vestibular functioning tests like Fukuda-Unterberger’s test (stationary marching with eyes closed for a minute), Dix Hallpike Test( Making you lie down with head hanging at 450 and turned to one side for atleast 45 seconds) for BPPV and Rhomberg’s test (standing with feet together, eyes closed and open, with arms on the sides, for 10 seconds each) are carried out. A CT scan or MRI scan is done. Furthermore, tests for hearing, vision, and blood work are recommended.
Stages of Vertigo
- Mild - The dizzy spells last briefly and go away on their own.
- Moderate - It is more symptomatic and requires the individual to lie still.
- Severe - Even after lying down, there is a sensation of constant movement. This is accompanied by nausea and vomiting.
Alternate Name
Dizziness
Differential Diagnosis
One should not confuse vertigo with fear of heights (acrophobia). Vertigo is one of the symptoms of acrophobia. It is important to distinguish vertigo from conditions like lightheadedness and imbalance. Other conditions associated closely with vertigo include anxiety disorders, anaemia, multiple sclerosis, stroke, meningitis, and brain neoplasms.
Possible Treatment of Vertigo
- Medication - Vestibular sedatives are prescribed.
- Vestibular rehabilitation training - It comprises a set of exercises to regain balance and maintain posture. They include eye, head and shoulder movements in the sitting and standing positions, gaze focusing and mobility exercises.
- Epley manoeuvre or canalith repositioning procedure (CRP) - The calcium crystals (otoliths) in the inner ear canals are responsible for movement detection. The CRP involves head manoeuvres that move the otoliths to a position where they cause no disturbance in signalling.
- Surgery - Canal plugging surgery and microvascular decompression surgery are recommended in severe cases.
Epidemiology
- Age - It is more common in individuals above 65 years.
- Gender - It is thrice more prevalent in women.
- Race - Studies show greater frequency in African-Americans and Asians, as compared to their Caucasian counterparts.
- Prevalence - It affects about 20% of adults annually. In India, BPPV affects about 107 per 100,000 yearly.
Expected Prognosis
BPPV has a recurrence rate of 50% in five years. Individuals with peripheral vertigo experience a recovery rate of up to 90% with the Epley manoeuvre treatment.
Natural Progression
Episodes of vertigo are sporadic and affect the quality of life, if left untreated. Mild cases may get better without treatment. If the underlying cause is not treated, it leads to long-term health complications.
Risk Factors
- Migraine - This is associated with spells of dizziness.
- Age - It is common in 70% of individuals aged above 65 years.
- Family history - Vertigo can be a symptom of hereditary syndromes.
- Past instances - Previous episodes of dizziness are concerning factors.
- Medical conditions - Diabetes, arrhythmia, ataxia, syphilis, and multiple sclerosis may trigger vertigo.
- Anxiety - Stress hormones (cortisols) are potential risk factors as they affect the vestibular system.
- Pregnancy - Hormonal changes during pregnancy may induce vertigo.
Primary Prevention
- Avoiding stress - Preventing anxiety attacks reduces the risk factors.
- Preventing head injury - Taking care to prevent falls and wearing a helmet while riding or playing sports, are of assistance.
- Lifestyle changes - Regular exercising and preventing lifestyle diseases like diabetes, high cholesterol and hypertension, are beneficial.
- Dietary considerations - Limiting salt intake, caffeine, sugary stuff, tobacco, and alcohol helps to ward off symptoms.
- Relaxation techniques - Sleeping well, yoga, and tai chi are useful.
Secondary Prevention
- Self treatment - Getting up slowly, avoiding sudden head jerks, sleeping with the head elevated, and squatting while picking something up, should be practised.
- Avoiding certain activities - It is best not to indulge in driving or climbing ladders if there have been dizzy spells in the past.
- Minimum exposure to bright light - Steer clear of bright lights.
- Using support - Use a cane while walking, to avoid unnecessary falls.
- Vitamin D supplementation - Taking vitamin D and calcium supplements prevents recurrence of symptoms.
- Alternative treatments - Herbal remedies and acupuncture techniques may help.
Possible Complications
Individuals with vertigo are advised against the handling of heavy machinery. Vertigo is linked to unexpected falls, which may lead to bone fractures and injuries. Severe cases are linked with paralysis of limbs, slurring of speech, irregular heartbeat and vestibular nerve damage.
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