Understanding Vertigo - Frequently Asked Questions about a spinning problem



Vertigo - the spinning problem




What is Vertigo ?


The term vertigo has been derived from the latin word ‘ vertere’ that means ‘to turn’.

Simply put it is a sensation that might be described as a pre-syncope, light-headedness, disequilibrium to describe that feeling of floating in our environment and losing our sense of direction.



Q. How does the brain measures balance ?



The balance is a perception of how things look around in our environment and how we adjust to that perception in terms of understanding our position and the position of the objects around us relative to us.


Balance is measured by our balance organ which is our inner ear and it is also called Vestibular system. Apart from inner ear - visual inputs from eyes and position sense from the sensory nerves also guide us regarding balance. All these signals are then transmitted to the brain through nerves which act like a wire transmitting electrical signals.

The vestibular system comprises the labyrinthine part of the inner ear and its connections in the brainstem and cerebellum, which are the balance centers of the brain.


Vestibular System :





Vertigo is caused by the abnormal functioning of the vestibular system that is responsible for managing our balance, motion perception and response of eye movements to different positions.


Q. How common is vertigo ?


The studies suggest highly variable prevalence due to non-uniformity of the studies methodologies and the cultural differences. The studies quote the prevalence to be less than 1% in community based Indian studies to 42 % in Portuguese study. The variability is quite glaring and due to differences in study methodology, different definitions of vertigo that were used and the study population.


Q. What are the types of vertigo ?


Broadly, vertigo may be classified as peripheral and central in etiology.

  • Peripheral vertigo means that it is originating at the ear end of the vestibular system

  • Central vertigo means that the cause lies somewhere in the brain.


Q. What are the common causes of Peripheral vertigo ?


Common causes of the peripheral vertigo are:

Benign paroxysmal positional vertigo (BPPV), thought to be caused by a displacement of otolith particles, calcium deposits in the inner ear, is the most common type of peripheral vertigo in the clinical practice, twice as common in women than men, usually affects older people and most often arises without a known cause (idiopathic). While most cases are spontaneous, BPPV vertigo can also follow head injury, reduced blood flow in a certain area of the brain (vertebro-basilar ischemia), labyrinthitis: inflammation of the inner ear labyrinth and vestibular nerve (the nerve responsible for encoding the body's motion and position), ear surgery, prolonged bed rest.


Other common peripheral causes of vertigo are :


  • Vestibular neuronitis - this is thought to be due to inflammation of the vestibular nerve.

  • Ménière's disease: caused by inflammation, usually infectious & thought to be caused by high pressure of a fluid in a compartment of the inner ear .


Q. What are common causes for central vertigo ?


Central vertigo is a term that collects together the central nervous system causes - involving a disturbance to one of the following two areas: The parts of the brain (brainstem and cerebellum) that deal with interaction between the senses of vision and balance, or sensory messages to and from the thalamus part of the brain.

Most common of the central vertigo is Vertiginous Migraine that would be associated with the headache.


Other rare but important causes are:


  • Stroke and transient ischemic attack

  • Lesions in Cerebellum ( which is the balance scale in the brain ) e.g. inflammation / infection or tumor

  • Acoustic neuroma (a non-cancerous growth on the vestibulo-cochlear or acoustic nerve in the brain)

  • Multiple sclerosis


Let's make one thing very clear, that cervical spondylosis is not a cause of the vertigo as most of us try implying cervical spondylosis as the cause of our unexplained giddiness. Though emotional upheavals may sometimes cause pre-syncope type of states that may be confused with vertigo and may be misinterpreted leading to unnecessary investigation. So it is important that you be sure of your biases while presenting your complaints to a clinician.

As described above, most of the causes of vertigo are benign and there is nothing to worry about. But you should still know the red flag signs that would tell you when to seek medical guidance regarding further investigations in a case of persistent vertigo.


Q. When and whom should I consult for vertigo ?


Please consult a Neurologist if there is:

  • worsening vertigo or disequilibrium

  • imbalance or in-coordination of the movement

  • associated non relieving headache

  • recurrent vomiting

  • loss of consciousness associated with vertigo

  • double or blurred vision

  • speech difficulty

  • limb weakness


Peripheral vertigo should be best evaluated by an ENT expert. So, ENT opinion is warranted if vertigo is:

  • short duration

  • episodic

  • postural vertigo

  • associated with hearing loss and /or tinnitus


Medications are prescribed according as per the cause of the vertigo. Apart from the medicine your doctor might prescribe you a few exercises that might improve your vestibular system function ( Brandt Daroff Exercises ) and hence the vertigo.



Author:

Dr Sweta Singla

Senior Consultant

Neurology & Sleep Medicine

Kalpavriksh Superspeciality Center

www.kvsc.in

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