Lightheadedness and vertigo differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
A number of specific conditions can cause vertigo. In the elderly, however, the condition is often multifactorial
Differentiating Lightheadedness and Vertigo from Other Symptoms
Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder[1] 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.[2] Patients with BPPV may experience brief periods of vertigo, usually under a minute, which occur with change in position.[3] It is the most common process of vertigo.[4] It occurs in 0.6% of the population yearly with 10% having an attack during their lifetime.[4] It is believed to be due to a mechanical malfunction of the inner ear.[4] BPPV may be diagnosed with the Dix-Hallpike test and can be effectively treated with repositioning movements such as the Epley maneuver.[4][5][3][6]
Vestibular migraine
Vestibular migraine is the association of vertigo and migraines and is one of the most common causes of recurrent, spontaneous episodes of vertigo.[4][1] The etiology of vestibular migraines is currently unclear;[1] however, one hypothesized cause is that the stimulation of the trigeminal nerve leads to nystagmus in individuals suffering from migraines. Other suggested causes of vestibular migraines include: 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.[7] Vestibular migraines are estimated to affect 1-3% of the general population and may affect 10% of migraine patients.[2] Additionally, vestibular migraines tend to occur more often in women than in men and rarely affect individuals after the sixth decade of life.[1]
Ménière's disease
Ménière's disease is a vestibular 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). However, this idea has not been directly confirmed with histopathologic studies but electrophysiologic studies have been suggestive of this mechanism.[8] 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][10][8] As the disease worsens, hearing loss will progress.
Vestibular neuritis
Vestibular neuritis presents with severe vertigo[4] with associated nausea, vomiting, and generalized imbalance and is believed to be caused by a viral infection of the inner ear though several theories have been put forward and the etiology remains uncertain.[9][11] Individuals with vestibular neuritis do not typically have auditory symptoms but may experience a sensation of aural fullness or tinnitus.[11] Persisting balance problems may remain in 30% of people affected.[4]
References
- ↑ 1.0 1.1 1.2 1.3 von Brevern, M; Neuhauser, H (2011). "Epidemiological evidence for a link between vertigo and migraine". Journal of vestibular research: equilibrium & orientation. 21 (6): 299–304. doi:10.3233/VES-2011-0423. PMID 22348934.
- ↑ 2.0 2.1
- ↑ 3.0 3.1 MedlinePlus (2011). "Benign positional vertigo". U.S. National Institutes of Health. Retrieved 2 January 2013.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6
- ↑
- ↑ Prim-Espada, MP; De Diego-Sastre, JI; Perez-Fernandez, E (2010). "[Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]" (PDF). Neurologia. 25 (5): 295–299. PMID 20643039. Unknown parameter
|month=ignored (help) - ↑
- ↑ 8.0 8.1 Semaan, MT; Megerian, CA (2011). "Ménière's disease: a challenging and relentless disorder". Otolaryngologic clinics of North America. 44 (2): 383–403. doi:10.1016/j.otc.2011.01.010. PMID 21474013. Unknown parameter
|month=ignored (help) - ↑ 9.0 9.1
- ↑
- ↑ 11.0 11.1 Goddard, JC; Fayad, JN (2011). "Vestibular Neuritis". Otolaryngologic Clinics of North America. 44 (2): 361–365. doi:10.1016/j.otc.2011.01.007.