“But I have vertigo… I lose my equilibrium easily. I can lean out to look at something and just keep leaning and not realize I’m about to fall.”
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Vertigo is a descriptive term for a sensation that there’s movement between you and your environment. It is a specific type of dizziness accompanied by spinning, swaying sensations that can make you feel unsteady. When a person complains of dizziness or about feeling the motion of objects while being stationary, it’s definitely a display of this disorder and can be similar to motion sickness. This may be associated with nausea, vomiting, sweating, or difficulties in walking. It typically worsens with the movement of the head and neck. Nearly 40% of people over the age of 40 are affected at least once in their lifetime with this disorder. Vertigo is not a disease nor is it the fear of heights, but rather a symptom of a vestibular disorder.
Vertigo is caused due to a mismatch between your sensory inputs that are responsible for maintaining posture. It is usually classified into two types according to the area of dysfunction in vestibular pathway, namely
Patients can have vertical and non-fatigable or continuous nystagmus in this type of vertigo. Other cranial nerve abnormalities, motor or sensation losses or instability can also be associated with this type. Usually imaging is required to figure out what is going on in the brain. This occurs due to an injury to the balance centre in central nervous system i.e. in the brain (specifically in the brain stem or the back of the brain)
If the patient is having peripheral vertigo, they can have horizontal and fatigable nystagmus. Sometimes when you have Benign Paroxysmal Positional vertigo (BPPV) you may also experience torsional nystagmus. Peripheral vertigo occurs when there is problem or damage to the centre in the inner ear that controls balance. This area is called as vestibular labyrinth. The damage incurred may also involve vestibular nerve that connects the inner ear with the brain stem.
Signs & Symptoms
The symptoms of vertigo can arise from many different parts of the body. Vertigo and disequilibrium can often have symptoms that can be associated with serious diseases, hence it is important to evaluate them properly. But Vertigo alone can also make a person sick. The signs and symptoms of vertigo can present as a persistent (insidious) onset or an episodic (sudden) onset and can last for a smaller amount of time (minutes/seconds) to a more memorable amount of time. It’s often associated with the below mentioned signs & symptoms, making the situation worse for the sufferer
- Spinning of surrounding objects
- Difficulty in maintaining balance
- Vomiting is projectile in vertigo i.e. the patient may suddenly throw up
- Jerking of eye (Nystagmus) – tweaking sensation in the eyelid muscles
- Generally feeling unwell
- Ringing in ears – this happens due to the damage in the
Causes Or Risk Factors
The causes or risk factors of vertigo vary according to imbalance caused in the inner ear or a problem with the central nervous system (CNS). Some of the symptoms appear to involve specific genetic factors and the cause may run in families as well (can be genetic but not always). The more prevalent causes can be
Causes Of Central Vertigo
- Diseases of blood vessels supplying blood to and fro from the brain
- Underlying diseases like multiple sclerosis, stroke, epilepsy, headache etc
- Tumor in brain which can either be malignant or benign (non cancerous)
- Excessive alcohol consumption
- Side effects of certain medications like anticonvulsants, blood thinners etc.
Causes Of Peripheral Vertigo
- Labyrinthitis i.e. swelling and irritation of the inner ear
- Vestibular Neuronitis i.e. inflammation of the vestibular nerve, which runs into the inner ear and sends messages to the brain that help control balance
- Tumor on the vestibular nerve compressing it
- Head injury/ Migraine
- Diseases like BPPV & Ménière’s disease
- Medications like some antibiotics, diuretics etc which are toxic to the inner ear
Diagnosis and Treatment
It’s crucial to get proper diagnosis of vertigo done since there can be many underlying causes which may have be left untreated and have gone undiagnosed resulting into severe vertigo disorders. After getting the patient’s medical history, a medical professional performs a physical examination that often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to central or peripheral causes. Following are some diagnostics tests that are performed to rule out vertigo.
- Head Movement Test
- Eye Motion Test
- Rotating Chair Test
- Along with these tests, some cases may even need an X-ray, CT brain or MRI for better clarity on the location of the disorder
If there’s any underlying cause to the disorder, then that needs to be treated first in order to get rid of vertigo on a more micro level. There are various treatments available for this and some suggested treatments can be:
- Oral medications like Antihistamines and Anticholinergics drugs (not to be taken without expert guidance)
- Balance Therapy i.e. practising balance exercises like marching at one place, Romberg exercise etc.
- Vestibular Therapy
- Head Position Maneuvers – there are two maneuvers called as Epley Maneuver & Semont Maneuver which are performed under the guidance of the expert to help treat vertigo
- Surgical Intervention is done in case there is any tumor or infection causing vertigo
Vertigo can happen to anyone, and there is no way to prevent the first episode. Because vertigo can be associated with an intense sense of imbalance, it is important to avoid situations in which a fall could cause significant harm, like climbing a ladder or working on a slanted roof. Call our doctor (neurologist) if you have an episode of vertigo, especially if it is associated with headache and significant coordination problems. We can help!
If you wish to speak to our doctor for a second opinion regarding this disorder, don’t hesitate to call us directly on 020 71529555 or fill in a request ‘here‘ for us to get in touch with you.