Vertigo is common and has a variety of causes. Symptoms often respond to desensitzing maneuvers or medication.
The term vertigo is used to describe the illusion of moving or spinning within one’s environment. Symptoms result from false messages reaching processing centers in the brain that are responsible for movement and balance. Vertigo ranges in severity from very mild and transient to severe and incapacitating.
Vertigo is often accompanied by nausea, sweating, and abnormal eye movements (nystagmus). Vertigo has several causes, and treatment varies according to the underlying pathology.
Causes of Vertigo
Benign paroxysmal positional vertigo (BPPV): This most common form of vertigo is usually initiated by moving the head suddenly or in a particular direction. Many experts believe BPPV is the result of degenerative changes in the inner ear that lead to the formation of canaliths (tiny particles in the semicircular canals of the inner ear). (Radtke A, et al. A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo. Neurology 1999;53:1358-60)
Meniere’s disease: This syndrome, caused by the relative overproduction of fluid in the inner ear, consists of three symptoms: vertigo, tinnitus (ringing in the ears), and hearing loss. Symptoms may be unilateral.
Acute vestibular neuronitis or labyrinthitis: Vertigo arises from inflammation of the inner ear or vestibular nerve. The most common cause is viral or bacterial infection.
Acoustic neuroma: Small tumors along the acoustic nerve can cause vertigo and unilateral hearing loss and tinnitus.
Migraine: Vertigo that is part of the aura that precedes a migraine headache is usually self-limited.
Head trauma: Injuries to the brain are often associated with vertigo. In most cases, the vertigo resolves over weeks to months.
Multiple sclerosis: When certain areas of the brain are damaged by MS, vertigo may result.
Vascular insult: Strokes or other phenomena that reduce blood flow to specific areas of the brain can cause vertigo.
Medications: A wide variety of medications and toxins can cause vertigo (e.g., alcohol, anticonvulsants, antidepressants, antihypertensives, sedatives, antihypertensives, etc).
Cholesteatoma: A cystic collection of keratin and debris, usually involving the middle ear space and the mastoid sinus.
Anxiety or other psychological conditions may cause vertigo.
Treatment for Vertigo
Medications are frequently prescribed for vertigo that lasts several hours to days, but drugs are less useful for episodes that only last seconds or minutes. Medications are also not recommended for vertigo lasting more than a few days; they only delay the brain’s ability to adapt to the aberrant vestibular input.
Vestibular rehabilitation exercises are commonly used in the general treatment of vertigo. These maneuvers help the brain to adapt to the new sensory input.
Canalith repositioning maneuvers are effective for treating BPPV. These exercises transfer canaliths from the semicircular canals to the vestibule of the inner ear, thus decreasing the false messages originating from the semicircular canals.
When bacterial causes of labyrinthitis or acoustic neuronitis can be identified, antibiotics are prescribed. (Many of these cases are caused by viruses that don’t respond to antibiotics).
Acoustic neuromas and cholesteatomas are typically treated surgically.
Meniere’s disease usually responds to medications that decrease the production of fluid in the inner ear. Surgery for Meniere’s is rarely required.
When migraines, anxiety, and psychiatric conditions are appropriately treated, the accompanying vertigo also improves.
Victims of stroke and head trauma—as well as patients with MS—often respond to vestibular rehabilitation exercises and/or watchful observation.
Medications that cause vertigo should be changed or discontinued.
Vertigo can significantly affect one’s ability to safely perform activities of daily living. In most cases its impact is transient and manageable. Persistent vertigo or symptoms that recur should prompt consultation with a health care professional.
The copyright of the article Vertigo: Causes and Management in Neurological Illness is owned by Stephen Allen Christensen. Permission to republish Vertigo: Causes and Management in print or online must be granted by the author in writing.
I suffered Vest. Neuronitis 2 yrs ago now 2006 and just recently had what I
thought was a relapse although my ENT Spec. assured me it was not. I now
suffer from persistent 'light headedness' and sometimes dull headaches
leaving me feeling like I am suffering the effects of a 'hangover' I have
been back to my ENT Spec. who continues to try different nasal sprays
without clearing up my symptomns. I am not suffering 24/7 just seems to
come and go but appears to get better then I get another bout. Can someone
help me with what I might have and what can/may clear this up. I am also
getting issues with my eyesight in that I regularly find myself blinking to
clear what appears to be a 'film' across my eyes. I have had my eyes
checked and have been told I am longsighted and now wear glasses for
reading and computer work. Any advice would be greatly appreciated.
Richard
Jan 18, 2009 8:25 AM
Stephen Allen Christensen :
Hello, Richard. Sometimes medical specialists suffer from narrow focus
themselves. It's possible that all of your symptoms go together. One of my
mentors handed me a pearl of medical wisdom a long time ago that served me
repeatedly in my practice: "Whenever a patient has multiple symptoms,
try to fit them together...until you can't." I would recommend
that you see a neurologist (or an inquisitive internist or family
practitioner). I have several suggestions for a workup (a brain MRI springs
to mind), but you need someone who can hear your story, lay their hands on
you, and chase things down in a reasonable fashion. Good luck.
Jan 18, 2009 9:22 AM
Guest :
Thank you for this very useful forum. If one's vertigo is caused by some
type of inner-ear inflammation (acute vestibular neuronitis or
labyrinthitis), what is the method of diagnosis? The inner-ear specialist I
visited never tested for any type of inflammation. I've had this condition
for five years now.
Also, if the condition is caused by acoustic
neuroma, can these inner-ear tumors along the acoustic nerve be identified
by MRI and, if not, how?
I've also often wondered if a tiny
camera (the kind sometimes swallowed, like a pill, to aid doctors in
diagnosing certain conditions)and sensors to measure inner-ear pressure
could be used in diagnosis. Many thanks.
Jan 19, 2009 6:56 AM
Stephen Allen Christensen :
Good questions. Acute labyrinthitis and vestibular neuronitis are
typically diagnosed clinically; history and physical examination (including
the use of provocative maneuvers) are usually sufficient. No specific
laboratory tests are really helpful. If vertigo persists or worsens in
spite of therapy, further workup is needed. MRI is most commonly used for
identifying acoustic neuromas. Measurement of perilymphatic or
endolymphatic pressures is not widely used due to difficulties in
establishing clinical parameters; research to date has not clearly shown
this modality to be useful. Electrocochleography (ECOG)--where fine
electrodes are introduced through the eardrum to rest against the hair
cells of the inner ear--is an accepted method for diagnosing Meniere's
disease and perilymphatic fistula (an abnormal connection between the
fluid-filled perilymphatic space and the air-filled middle ear space). ECOG
is readily available to most otolaryngologists, although it isn't often
performed during an initial evaluation.
Feb 18, 2009 8:10 PM
Guest :
Thank you so much for this informative article. I was diagnosed with Lyme
disease many years ago and thought it had gone away. Three years ago, I
found myself getting dizzy, especially when I was on my computer. Then,
after a horrible fever, violent vomiting, and a trip to the ER, the
dizziness came back at a great intensity and wouldn't let go. It lasted
months. It felt like I was on a boat all day long. Whole room moving,
like a boat. No loss of balance, so it would seem like vertigo, not
dizziness. Occasional neck and shoulder cramps too, which I have read is
consistent with a certain type of "neck vertigo". I went to ENT
and discovered that I had 15% loss of hearing in my left ear since the
begining. Went to the House Clinic and they could find nothing.
I had an MRI at that time (3 years ago) and there were two tiny lesions
in my brain consistent with Lyme. I revisited my Lyme doctor (very
respected) and got serious about medication. I have been on various
courses of antibiotics for Lyme (levaquin, doxycycline, omoxycillin) and my
other Lyme symptons (muscle twitches, muscle cramps, insomnia, night
sweats, heart palpatations) have all abated. The dizziness did too, for a
year, until 15 months ago. But it is now back to its earlier intensity.
Yearly MRIs have shown the lesions to have gotten smaller,
which is also consistent with the effects of Lyme treatment. I have been
told that the location of the lesions is not consistent with dizziness.
Do you have any advice or do you know any specialist in the Los
Angeles area for vertigo or neurotology? Most LA neurologists are not well
versed in Lyme, so they are quick to say MS even though every neurologic
physical exam I've had for three years shows zero signs of MS. Plus the
lesions got smaller. Can you offer any thoughts? Thank you so much.
Feb 19, 2009 10:53 AM
Stephen Allen Christensen :
I'm not familiar with any physicians or neurotology clinics in the LA area.
I'm a bit familiar with Dr. Sean McMenomey at OHSU's Dept. of
Otology/Neurotology/Skull Base Surgery in Portland, OR. They do good work
there, but I don't know how they're disposed toward the treatment of Lyme
disease. Your vertigo may not necessarily be associated with Lyme
disease. I've always been puzzled by the medical profession's
reticence to deal aggessively with Lyme. Borrelia is a spirochete, and in
many ways it acts like its cousin, syphilis (the "great
pretender"). We've learned a great deal about syphilis over the years,
including its proclivity to hide out in various organs for decades. Should
Lyme be any different? Part of our hesitation might be due to the
fact that we don't have a highly sensitive and specific way to screen for
active Lyme disease. And empiric treatment based on a constellation of
symptoms that mimic other conditions is fraught with pitfalls. It is
also possible that pressure from medical boards, health departments, and
the insurance industry precludes many physicians from diagnosing Lyme
disease more frequently. Oregon's Dept. of Public Health requires a
"physician-documented" case of erythema migrans (the classic
rash) along with a positive serology before Lyme can be diagnosed. Well, EM
occurs in 75-80% of cases, but not ALL cases. And, even if a person
develops the rash, how many people fail to go to a doctor immediately? It might seem a bit paranoid to think there are unscrupulous forces
behind our inattention to Lyme, but I've known of docs who were sanctioned
for treating patients with Lyme disease--particularly when the doctors
became well-versed in the condition and acquired a panel of sick people who
weren't getting appropriately treated elsewhere. Whoever treated you
for Lyme might be interested in seeing you again. Even though you've gone
through several courses of antibiotics, some symptoms of Lyme can persist
after treatment. And, although you're probably already better
educated than many physicians about Lyme, you might want to get a copy of
the book: Beating Lyme: Understanding and Treating This Complex and Often
Misdiagnosed Disease By Constance A. Bean, Lesley Ann Fein, Sam T.
Donta (2008) Good luck!
Jun 17, 2009 4:47 PM
Guest :
I was diagnosed this week with an inner ear infection after a severe bout
of vertigo where I vomited and spun for 12 hours before I was able to get
up and walk again. Doc has me on mecilzine for nausea and dizziness (which
is much less severe - only when I turn fast or lean). Is there anything
else I can do to get over this quickly? Or prevent it from happening
again?
Jun 17, 2009 9:40 PM
Stephen Allen Christensen :
The diagnosis of "inner ear infection", or acute labyrinthitis,
is usually made clinically--that is, no special tests are done to rule out
other causes; your doctor made the diagnosis based on your history and
physical examination. If you haven't had an upper respiratory infection
lately, you could just as easily be suffering from BPPV or another cause of
vertigo. The meclizine often helps with the symptoms of vertigo, no matter
the cause. In the case of acute labyrinthitis, the symptoms gradually
improve over a period of several days to weeks. If you're not seeing such
improvement it might be worth trying the canalith repositioning maneuvers
(see the link in the article). Be aware that such maneuvers in a person
with inner ear infection could temporarily worsen your symptoms. Patience
is the key to dealing with most cases of vertigo. As for prevention,
the usual things we do to prevent colds (hand washing, avoiding touching
the eyes,nose, or mouth during cold season, etc.) will help to prevent
inner ear infections, too. BPPV can be addressed whenever it occurs by
simply repeating the maneuvers. I hope you get better soon. Vertigo
is always unpleasant.
Nov 29, 2008
