Vertigo

Dizziness is an illusion of motion known medically as “vertigo” and described by patients as the sense that they or their surroundings are spinning. It is one of the most common neurological complaints. Patients sometimes say that the objects around them are spinning, and sometimes they feel like the ground is slipping under their feet. Nausea and vomiting are other complaints that frequently accompany dizziness.

In general, the incidence of vertigo in the population increases with age. Dizziness in each age group brings to mind different causes. The most common causes of vertigo can be listed as follows;

• Benign Paroxysmal Positional Vertigo (BPPV): It is one of the most common causes of dizziness. It is explained by the abnormal movement of crystals, which play a role in our understanding of our position in space, dislodging and migrating to the semicircular canals positioned in three different planes within the inner ear. It often appears suddenly. It is adversely affected by sudden movements of the head. It can be treated in a short time with drug therapy or special maneuvers.
• Meniere’s Disease: It progresses with dizziness, tinnitus, and progressive hearing loss due to an undesirable increase in the fluid in the canals of the inner ear. This situation is followed by ENT specialists.
• Vestibular Neuritis (Inflammation of the vestibular nerve): It progresses with low-severity but prolonged vertigo attack, which is generally seen in seasonal transitions and thought to be associated with some viruses. It can be kept under control by rest and medication.
• Cerebellar Vertigo (Dizziness due to Cerebellar disorders): It is a condition that occurs as a result of stroke, multiple sclerosis, some degenerative or infectious diseases that directly affect the cerebellum. In addition to sudden onset of dizziness, patients experience gait disturbance, distance perception disorder, headache, nausea, and vomiting. It is a life-threatening condition that requires an urgent referral to a neurologist.
• Vertiginous Migraine:  It is known for migraine-like headache attacks following dizziness. It can be kept under control by migraine treatment.
• Vertebrobasilar Insufficiency: It is a common cause of dizziness in the middle-aged and older group. Dizziness often begins with standing up and ends abruptly. Symptoms such as vision loss, double vision, slurred speech, weakness, or numbness may also accompany.
• Multiple Sclerosis: It should be considered especially in dizziness attacks that start in middle age and before. It can be diagnosed easily by neurologists.
• Cerebellopontine Angle Tumors: They are tumors arising from the sheath of the hearing and balance nerve. They are usually benign tumors and surgical removal is sufficient.

Other causes;

• Anemia
• Various vitamin deficiencies, most commonly vitamin B12
• Due to damage after long-term alcohol use
• As a drug side effect, often cancer drugs and tuberculosis drugs
• In some epileptic seizures

What is Vertigo?

Vertigo is a symptom in which a person feels that they or the objects around them are moving while still. It often feels like a tilting or rocking motion.

Symptoms;

• Nausea
• vomiting
• sweating
• Walking difficulties

It is worse when the head is moved. The most common diseases that result in vertigo are benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and labyrinthitis.

Less common causes;

• stroke
• brain tumors
• brain damage
• multiple sclerosis
• migraine
• trauma
• uneven pressures between the middle ears.

Physiological vertigo can occur only after prolonged exposure to motion following bending with eyes closed, such as when on a ship. Other causes may include exposure to toxins such as carbon monoxide, alcohol, or aspirin. Vertigo typically indicates a problem with some part of the vestibular system.

Other causes of dizziness include presyncope, imbalance, and nonspecific dizziness. Benign paroxysmal positional vertigo is more likely in a person who has repeated episodes of vertigo with movement and is normal between these episodes.

Vertigo attacks should last less than a minute. The Dix-Hallpike test typically produces a period of rapid eye movements, in this case, known as nystagmus. In Ménière’s disease, episodes of ringing in the ears, hearing loss, and vertigo usually last more than twenty minutes. In labyrinthitis, the onset of vertigo is sudden and the nystagmus appears immobile. In this case, vertigo can last for days.  More serious causes should be considered in cases accompanied by headaches, difficulty in speaking, and double vision.

Dizziness affects about 20-40% of people at a given time, while 7.5-10% have dizziness. About 5% of people have vertigo in a given year. It becomes more common with age and affects women two to three times more often than men. Vertigo accounts for approximately 2-3% of emergency room visits in the developed world.

Why Does Vertigo Occur?

The most common causes of vertigo are inner ear infections or ear diseases such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere’s disease. It can occur when calcium builds up in the canals of the inner ear, causing a brief dizziness that lasts from 20 seconds to a minute. It is usually brought on by trauma to the head or by moving the head in certain positions.

Vestibular neuritis occurs with an inner ear infection that causes inflammation around the nerves that help the body sense balance. It results in a severe episode of vertigo that can last a day or longer and sometimes includes hearing loss. It is caused by the buildup of fluid and pressure in the inner ear and can cause dizziness along with ringing in the ears and hearing loss. Less common causes of vertigo can include head or brain injuries or migraines.

Additional Information About Vertigo

Vertigo is a symptom rather than a condition. It’s the sensation that you, or the environment around you, is moving or spinning. This sensation may be barely noticeable, or it may be so severe that you find it difficult to keep your balance and do daily tasks. Vertigo attacks can develop suddenly and last for a few seconds or may last much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making normal life very difficult.

How is Vertigo treated?

Some cases of vertigo improve over time, without treatment. However, some people have repeated episodes for many months, or even years, such as those with Ménière’s disease. There are specific treatments for certain causes of vertigo. A series of simple head movements (known as the Epley manoeuvre) is used to treat BPPV.

Medicines, such as some antihistamines, can help in the early stages or most cases of vertigo. Many people with vertigo also benefit from vestibular rehabilitation training(VRT) , which is a series of exercises for people with dizziness and balance problems.

Vertigo is commonly caused by a problem with the way balance acts in the inner ear, although it can also be caused by problems in certain parts of the brain.