Vertigo
Vertigo | |
---|---|
disequilibrium, non-specific dizziness[2] | |
Frequency | 20–40% at some point[3] |
Vertigo is a condition in which a person has the sensation of movement or of surrounding objects moving when they are not.[1] Often it feels like a spinning or swaying movement.[1][2] It may be associated with nausea, vomiting, perspiration, or difficulties walking.[2] It is typically worse when the head is moved.[2] Vertigo is the most common type of dizziness.[2]
The most common disorders that result in vertigo are
Benign paroxysmal positional vertigo is more likely in someone who gets repeated episodes of vertigo with movement and is otherwise normal between these episodes.
Dizziness affects approximately 20–40% of people at some point in time, while about 7.5–10% have vertigo.
Classification
Vertigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway,[11] although it can also be caused by psychological factors.[12]
Vertigo can also be classified into objective, subjective, and pseudovertigo. Objective vertigo describes when the person has the sensation that stationary objects in the environment are moving.[13] Subjective vertigo refers to when the person feels as if they are moving.[13] The third type is known as pseudovertigo, an intensive sensation of rotation inside the person's head. While this classification appears in textbooks, it is unclear what relation it has to the pathophysiology or treatment of vertigo.[14]
Peripheral
Vertigo that is caused by problems with the
People with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, fullness, and pain in the ear.[16] In addition, lesions of the internal auditory canal may be associated with facial weakness on the same side.[16] Due to a rapid compensation[clarification needed] process, acute vertigo as a result of a peripheral lesion tends to improve in a short period of time (days to weeks).[16]
Central
Vertigo that arises from injury to the balance centers of the
A number of conditions that involve the central nervous system may lead to vertigo including: lesions caused by
Signs and symptoms
Vertigo is a sensation of spinning while stationary.[22] It is commonly associated with nausea or vomiting,[21] unsteadiness (postural instability),[19] falls,[23] changes to a person's thoughts, and difficulties in walking.[24] Recurrent episodes in those with vertigo are common and frequently impair the quality of life.[10] Blurred vision, difficulty in speaking, a lowered level of consciousness, and hearing loss may also occur. The signs and symptoms of vertigo can present as a persistent (insidious) onset or an episodic (sudden) onset.[25]
Persistent onset vertigo is characterized by symptoms lasting for longer than one day
The characteristics of an episodic onset vertigo are indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes.[25]
Pathophysiology
The neurochemistry of vertigo includes six primary
Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. Dopamine, histamine, serotonin, and acetylcholine are neurotransmitters thought to produce vomiting.[9] It is known that centrally acting antihistamines modulate the symptoms of acute symptomatic vertigo.[29]
Diagnosis
Tests for vertigo often attempt to elicit nystagmus and to differentiate vertigo from other causes of dizziness such as
The HINTS test, which is a combination of three physical examination tests that may be performed by physicians at the bedside, has been deemed helpful in differentiating between central and peripheral causes of vertigo.
Tests of
A number of specific conditions can cause vertigo. In the elderly, however, the condition is often multifactorial.[10]
A recent history of
Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder[3] and occurs when loose calcium carbonate debris has broken off of the otoconial membrane and enters a semicircular canal thereby creating the sensation of motion.[1][9] People with BPPV may experience brief periods of vertigo, usually under a minute,[9] which occur with change in the position.[35]
This is the most common cause of vertigo.
Ménière's disease
Ménière's disease is an inner ear disorder of unknown origin, but is thought to be caused by an increase in the amount of endolymphatic fluid present in the inner ear (endolymphatic hydrops).[1] However, this idea has not been directly confirmed with histopathologic studies, but electrophysiologic studies have been suggestive of this mechanism.[38] Ménière's disease frequently presents with recurrent, spontaneous attacks of severe vertigo in combination with ringing in the ears (tinnitus), a feeling of pressure or fullness in the ear (aural fullness), severe nausea or vomiting, imbalance, and hearing loss.[9][25][38] As the disease worsens, hearing loss will progress.
Vestibular neuritis
Vestibular migraine
Other suggested causes of vestibular migraines include the following: unilateral neuronal instability of the vestibular nerve, idiopathic asymmetric activation of the vestibular nuclei in the brainstem, and vasospasm of the blood vessels supplying the labyrinth or central vestibular pathways resulting in ischemia to these structures.[21] Vestibular migraines are estimated to affect 1–3% of the general population[1][10] and may affect 10% of people with migraine .[1] Additionally, vestibular migraines tend to occur more often in women and rarely affect individuals after the sixth decade of life.[3]
Motion sickness
Motion sickness is common and is related to vestibular migraine. It is nausea and vomiting in response to motion and is typically worse if the journey is on a winding road or involves many stops and starts, or if the person is reading in a moving car. It is caused by a mismatch between visual input and vestibular sensation. For example, the person is reading a book that is stationary in relation to the body, but the vestibular system senses that the car, and thus the body, is moving.
Alternobaric vertigo
Alternobaric vertigo is caused by a pressure difference between the middle ear cavities, usually due to blockage or partial blockage of one eustachian tube, usually when flying or diving underwater. It is most pronounced when the diver is in the vertical position; the spinning is toward the ear with the higher pressure and tends to develop when the pressures differ by 60 cm of water or more.[41][42]
Decompression sickness
Vertigo is recorded as a symptom of decompression sickness in 5.3% of cases by the U.S. Navy as reported by Powell, 2008[41] including isobaric decompression sickness.
Decompression sickness can also be caused at a constant ambient pressure when switching between gas mixtures containing different proportions of different inert gases. This is known as isobaric counterdiffusion, and presents a problem for very deep dives.[43] For example, after using a very helium-rich trimix at the deepest part of the dive, a diver will switch to mixtures containing progressively less helium and more oxygen and nitrogen during the ascent. Nitrogen diffuses into tissues 2.65 times slower than helium, but is about 4.5 times more soluble. Switching between gas mixtures that have very different fractions of nitrogen and helium can result in "fast" tissues (those tissues that have a good blood supply) increasing their total inert gas loading. This is often found to provoke inner ear decompression sickness, as the ear seems particularly sensitive to this effect.[44]
Stroke
A stroke (either ischemic or hemorrhagic) involving the posterior fossa is a cause of central vertigo.[33] Risk factors for a stroke as a cause of vertigo include increasing age and known vascular risk factors. Presentation may more often involve headache or neck pain, additionally, those who have had multiple episodes of dizziness in the months leading up to presentation are suggestive of stroke with prodromal TIAs.[33] The HINTS exam as well as imaging studies of the brain (CT, CT angiogram, MRI) are helpful in diagnosis of posterior fossa stroke.[33]
Vertebrobasilar insufficiency
Vertebrobasilar insufficiency, notably Bow Hunter's syndrome, is a rare cause of positional vertigo, especially when vertigo is triggered by rotation of the head.[45][46]
Management
Definitive treatment depends on the underlying cause of vertigo.
- hyoscine hydrobromide (scopolamine)[49]
- valproic acidfor vestibular migraines
- Antihistamines such as betahistine, dimenhydrinate, or meclizine, which may have antiemetic properties[citation needed]
- Beta blockers such as metoprololfor vestibular migraine
- Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis or dexamethasoneas a second-line agent for Ménière's disease
All cases of decompression sickness should be treated initially with 100% oxygen until
Etymology
Vertigo is from the Latin word, vertō, which means "a whirling or spinning movement".[51]
See also
- Acrophobia – Extreme fear of heights
- Broken escalator phenomenon – Illusion when stepping onto a broken escalator
- Chronic subjective dizziness – Type of dizziness (chronic functional vestibular disorder)
- Fear of falling – Natural fear typical of most mammals
- Head for heights
- Ideomotor phenomenon – Concept in hypnosis and psychological research
- Illusions of self-motion – Misperception of one's location or movement
- Proprioception – Sense of self-movement, force, and body position
- Motion sickness – Nausea caused by motion or perceived motion
- Sense of balance, also known as Equilibrioception – Physiological sense regarding posture
- Spatial disorientation – Inability of a person to correctly determine their body position in space
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External links
- "Dizziness and Vertigo". MedlinePlus. U.S. National Library of Medicine.