Vertigo overview
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Diagnosis |
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Vertigo overview On the Web |
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American Roentgen Ray Society Images of Vertigo overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Historical Perspective
- Vertigo is derived from the Latin words vertigin and vertere which means "a whirling or spinning movement," and "to turn", respectively.
Classification
- Vertigo is classified on the basis of the location of dysfunction into:
- Peripheral: Lesion in the inner ear or vestibulocochlear nerve.
- Central: Lesion in brainstem or cerebellum.
- It can also be classified on the basis of its time course or duration:
- Lasting a day or longer
- Lasting minutes to hours
- Lasting seconds
Pathophysiology
- Disruption in the vestibular system results in vertigo. The region of disruption could be peripheral (labyrinth, vestibular nerve) or central (brainstem, cerebellum).
- Vestibulo-ocular reflex is responsible for stabilizing gaze during head movement, it is controlled by six neurotransmitters, which are glutamate, acetylcholine, GABA, dopamine, histamine and norepinephrine.
Causes
- Common causes of vertigo:
- Peripheral: Benign paroxysmal positional vertigo (BPPV), Ménière's disease, acute labyrinthitis, vestibular neuritis, Herpes zoster oticus(Ramsay Hunt syndrome).
- Central: Ischemic/hemorrhagic stroke in the cerebellum or brainstem, tumor in cerebellopontine angle, vestibular migraine.
- Drug induced
- Psychological Vertigo
Differentiating Vertigo from other Diseases
- Vertigo is one of the four type of dizziness, therefore it must be differentiated from other forms of dizziness, presyncope, lightheadedness and disequilibrium.
Epidemiology and Demographics
- Among the patient who presents with dizziness in the primary care setting, fifty-four percent have vertigo upon investigation.
Risk Factors
- There are no established risk factors for vertigo, as it is a symptom of an underlying disease.
- However, vertigo can be prevented in some cases by controlling risk factors for the underlying cause.
Screening
- There is insufficient evidence to recommend routine screening for vertigo.
Diagnosis
Diagnostic Study of Choice
- There are no established criteria for the diagnosis of vertigo. Associated signs and symptoms should be identified to reach the underlying cause of vertigo.
History and Symptoms
- It is important to differentiate between other causes of dizziness before evaluating for the cause of vertigo. True vertigo is described as the room spinning around the patient.
- Once true vertigo is established next step is to identify if the origin of dysfunction is central or peripheral.
- Detailed investigation of time course and associated signs and symptoms aid in identifying the cause of vertigo.
Physical Examination
Laboratory Findings
- There are no diagnostic laboratory findings associated with vertigo.
Electrocardiogram
- There are no ECG findings associated with vertigo.
- ECG monitoring may be indicated if the cause of dizziness is uncertain.
X-ray
- There are no x-ray findings associated with vertigo.
Echocardiography or Ultrasound
- There are no echocardiography/ultrasound findings associated with vertigo.
CT scan
- CT scan is not the first-line imaging preferred to determine the underlying cause of central vertigo.
MRI
- An MRI is the first-line imaging if the cause of vertigo is suspected to be central in origin.
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
- Acute/severe attacks of vertigo usually subsides in a day or two after brainstem compensation.
- Supportive therapy includes bed rest, antihistamine, antiemetic (prochlorperazine, metoclopramide) to relief the symptom.
- Antihistamine (meclizine,betahistine,dimenhydrinate), antiemetic, anticholinergic (scopolamine) and benzodiazepines (diazepam,lorazepam) are the common medications used to treat vertigo as a symptom.
- These drugs should not be used for a long period of time as it may delay the compensatory mechanism in the brainstem and result in the prolongation of vertigo symptom.
- Some patients may be a candidate for vestibular rehabilitation.
- Treating the underlying cause is the definitive treatment of vertigo
Surgery
- For the majority of underlying causes of vertigo, the mainstay of treatment is medical therapy. Surgery is usually reserved for patients with either tumor-associated vertigo, cholesteatoma, and/or when it does not respond to multiple medical therapies.
Primary Prevention
- There are no established measures for the primary prevention of vertigo, as it occurs as a symptom of underlying pathology.
- In some diseases controlling risk factors or triggering factors can prevent the disease hence preventing the symptoms.
Secondary Prevention
- Effective measures for the secondary prevention of vertigo include optimal treatment of the underlying etiology.