Vertigo: Difference between revisions
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*There are no established risk factors for vertigo, as it is a symptom of an underlying disease. | *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 the underlying cause: | *However, vertigo can be prevented in some cases by controlling the underlying cause: | ||
**In [[vestibular]] [[migraine]] recognized triggers | **In [[vestibular]] [[migraine]] recognized triggers including altered sleep patterns, menstrual cycle, chocolate, red wine, ripened/aged cheese, should be avoided. | ||
**Avoid drugs or toxins that may cause vertigo. | **Avoid drugs or toxins that may cause vertigo. | ||
Revision as of 16:24, 4 December 2020
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Resident Survival Guide Vertigo in Children |
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Vertigo Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Vertigo On the Web |
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American Roentgen Ray Society Images of Vertigo |
For patient information, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Synonyms and keywords:
Overview
Historical Perspective
Classification
| Classification of Vertigo[2][3][4] | |||||||||||||||||||||||||||||||
| Based on Location of Dysfunction | |||||||||||||||||||||||||||||||
| Peripheral Accounts for over 90% of all causes of vertigo | Central | ||||||||||||||||||||||||||||||
| Lesion in inner ear or vestibulocochlear nerve | Lesion in brainstem or cerebellum | ||||||||||||||||||||||||||||||
| Meniere’s disease Benign positional paroxysmal vertigo Acute labyrinthitis Acute vestibular neuronitis Cholesteatoma Otosclerosis Perilymphatic fistula Acoustic Neuroma | Brainstem Stroke Vestibular Migraine Multiple Sclerosis Cerebellar ischemia or hemorrhage Cerebellar tumors lateral medullary syndrome Chiari malformation | ||||||||||||||||||||||||||||||
Pathophysiology
Causes
- Peripheral causes of vertigo includes[3]:
| Disease | Main Feature |
| Ménière’s disease | Increased endolymph volume in semicircular canals. Recurrent vertigo, aural fullness, hearing loss and tinnitus |
| Benign positional paroxysmal vertigo | Dislodged otoliths stimulate vestibular sense organ. Recurrent vertigo, nausea, vomiting, torsional nystagmus |
| Acute labyrinthitis | Inflammation of labyrinth/ viral or bacterial. Temporary hearing loss, vertigo, off balance, tinnitus |
| Acute vestibular neuritis | Inflammation of vestibular nerve caused by viral infection. Vertigo, hearing intact |
| Cholesteatoma | Cyst/sac of keratin debris in middle ear. Fullness/pressure in the ear, vertigo, hearing loss, pain |
| Otosclerosis | Abnormal bone growth in middle ear. Vertigo, tinnitus and, sensorineural hearing loss |
| Perilymphatic fistula | Abnormal connection between the middle ear and inner ear. Fullness/pressure in the ear, vertigo, hearing loss/sensitive hearing |
- Central causes of vertigo includes[5]:
| Disease | Main Feature |
| Brainstem Stroke | Vertigo, imbalance, double vision, slurred speech, and altered consciousness. |
| Vestibular Migraine | Mostly unilateral severe throbbing headache, vertigo lasting minutes to hours, sensitivity to motion/light/smell/noise, nausea, vomiting, imbalance. |
| Multiple Sclerosis | Vertigo may accompany other symptoms like vision problem, fatigue, numbness/tingling, limited mobility, bladder/bowel/speech/swallowing impairment. |
| Cerebellar tumors | meningioma or schwannoma in cerebellopontine angle can cause vertigo due to pressure on vestibular nerve. |
| Lateral medullary syndrome | Results from ischemia in the lateral part of the brainstem(medulla oblongata). Associated with ataxia, nystagmus, vertigo, dysphagia, dysarthria. |
| Chiari malformation | Extension of brainstem into spinal canal. Associated with numbness/tingling of hands and feet, dysphagia, vertigo, unsteady gait, hoarseness. |
Differentiating Vertigo from other Diseases
- Vertigo must be differentiated from other diseases that cause imbalance, dizziness, and lightheadedness.[6]
Epidemiology and Demographics
- Among the patient who presents with dizziness in the primary care setting, fifty-four percent have vertigo upon investigation.[7]
Screening
- There is insufficient evidence to recommend routine screening for vertigo.
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 the underlying cause:
- In vestibular migraine recognized triggers including altered sleep patterns, menstrual cycle, chocolate, red wine, ripened/aged cheese, should be avoided.
- Avoid drugs or toxins that may cause vertigo.
Natural History, Complications and Prognosis
- Complications include:
- Anxiety
- Depression
- Difficulty performing daily tasks
- Diminished quality of life
- Impaired balance and coordination
- Prognosis of vertigo depends upon treating the underlying cause. However, vertigo due to a tumor has a poor prognosis compared to other causes of vertigo.
Diagnosis
Treatment
- ↑ "Definition of vertigo". Merriam-Webster Online Dictionary.
- ↑ Dieterich, Marianne (2007). "Central vestibular disorders". Journal of Neurology. 254 (5): 559–568. doi:10.1007/s00415-006-0340-7. ISSN 0340-5354.
- ↑ 3.0 3.1 Karatas, Mehmet (2008). "Central Vertigo and Dizziness". The Neurologist. 14 (6): 355–364. doi:10.1097/NRL.0b013e31817533a3. ISSN 1074-7931.
- ↑ Guerraz, M. (2001). "Visual vertigo: symptom assessment, spatial orientation and postural control". Brain. 124 (8): 1646–1656. doi:10.1093/brain/124.8.1646. ISSN 1460-2156.
- ↑ Kerber, Kevin A. (2009). "Vertigo and Dizziness in the Emergency Department". Emergency Medicine Clinics of North America. 27 (1): 39–50. doi:10.1016/j.emc.2008.09.002. ISSN 0733-8627.
- ↑ Labuguen RH (2006). "Initial evaluation of vertigo". Am Fam Physician. 73 (2): 244–51. PMID 16445269.
- ↑ Kroenke, Kurt (1992). "Causes of Persistent Dizziness". Annals of Internal Medicine. 117 (11): 898. doi:10.7326/0003-4819-117-11-898. ISSN 0003-4819.