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Posted 03/04/2020

Vertigo refers to a sense of dizziness. It is a symptom of a range of conditions. It can happen when there is a problem with the ear, brain, or sensory nerve pathway.
Dizziness, or vertigo, can happen at any age, but it is common in people aged 65 years and over. Over 60 medical and psychiatric conditions can cause it, as well as some medications. Vertigo can be temporary or long term. Persistent vertigo has been linked to mental health issues. A psychiatric problem may cause the dizziness, or the vertigo may affect the person’s ability to function in daily life, potentially leading to depression.

A person with vertigo will have a sense that they, or their environment, are moving or spinning, even though there is no movement. Vertigo is a symptom, but it can also cause other symptoms
These include:
 * dizziness
 * balance problems and lightheadedness
 * nausea and vomiting
 * a sense of motion sickness
 * tinnitus(ringing in the ears)
 * a feeling of fullness in the ear
Vertigo is not just a feeling of faintness, but a rotational dizziness.

Causes and types
There are different types of vertigo, depending on what causes them.

Peripheral vertigo happens when there is a disturbance in the balance organs of the inner ear.

Central vertigo happens when there is a disturbance in parts of the brain known as sensory nerve pathways.

Labyrinthitis: This is an inflammation of the inner ear labyrinth and vestibular nerve, the nerve that is responsible for encoding the body’s motion and position. It is usually caused by a viral infection.

Vestibular neuronitis: This is thought to be due to inflammation of the vestibular nerve, usually due to a viral infection.

Cholesteatoma: A skin growth occurs in the middle ear, usually as a result of repeated infection. If the growth becomes larger, it can damage the ear, leading to hearing loss and dizziness.

Ménière’s disease: A buildup of fluid in the inner ear can lead to attacks of vertigo. It tends to affect people between the ages of 40 and 60 years.

According to The National Institute on Deafness and Other Communication Disorders (NIDCD), 615,000 people in the United States (U.S.) are currently receiving treatment for this condition. It may stem from blood vessel constriction, a viral infection, or an autoimmune reaction, but this is not confirmed.
Benign paroxysmal positional vertigo (BPPV): This is thought to stem from a disturbance in the otolith particles. These are the crystals of calcium carbonate within inner ear fluid that pull on sensory hair cells during movement and so stimulate the vestibular nerve to send positional information to the brain.

In people with BPPV, normal movement of the inner ear fluid continues after head movement has stopped.
BPPV usually affects older people and the cause is usually unknown, or idiopathic. It has been linked to dementia. It is twice as common in women as in men.
However, it can also follow:
 * a head injury
 * reduced blood flow in part of the brain, known as vertebrobasilar ischemia
 * labyrinthitis
 * ear surgery
 * prolonged bed rest
Drug toxicity and syphilis can also lead to inner ear disturbances.

Other, rarer causes of peripheral vertigo are:
 * perilymphatic fistula, a tear in one/both of the membranes separating the middle and inner ear
 * herpes zoster oticus, a viral infection of the ear, also known as Ramsay Hunt syndrome
 * otosclerosis, a genetic ear bone problem that causes hearing loss

Central vertigo
Central vertigo is linked to problems with the central nervous system.
It involves a disturbance in one of the following areas:
 * the brainstem and cerebellum, which are the parts of the brain that deal with interaction between the senses of vision and balance
 * sensory messages to and from the part of the brain known as the thalamus

Migraine headache is the most common cause of central vertigo. An estimated 40 percent of patients with migraine have some vertigo, which can involve disrupted balance, dizziness, or both, at some time.
Uncommon causes are:
 * stroke
 * transient ischemic attack
 * cerebellar brain tumor
 * acoustic neuroma, a benign growth on the acoustic nerve in the brain
 * multiple sclerosis

Tests and diagnosis
During an evaluation for vertigo, a health care professional may obtain a full history of the events and symptoms. This includes medications that have been taken (even over-the-counter medications), recent illnesses, and prior medical problems (if any). Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.

After the history is obtained, a physical examination is performed. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause. New symptoms of vertigo should be worked up to rule out stroke as the primary cause. History, physical exam, and imaging as needed are critical to insure any life-threatening conditions are ruled out. Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem. The Dix-Hallpike test is done to try to recreate symptoms of vertigo; this test involves abruptly repositioning the patient’s head and monitoring the symptoms which might then occur. However, not every patient is a good candidate for this type of assessment, and a physician might instead perform a “roll test,” during which a patient lies flat and the head is rapidly moved from side to side. Like the Dix-Hallpike test, this may recreate vertigo symptoms and may be quite helpful in determining the underlying cause of the vertigo. If indicated, some cases of vertigo may require an MRI or CT scan of the brain or inner ears to exclude a structural problem like stroke.

Vertigo Treatments
Some of the most effective treatments for peripheral vertigo include particle repositioning movements. The most well-known of these treatments is the Epley maneuver or canalith repositioning procedure. During this treatment, specific head movements lead to movement of the loose crystals (canaliths) within the inner ear. By repositioning these crystals, they cause less irritation to the inner ear and symptoms can resolve. Because these movements can initially lead to worsening of the vertigo, they should be done by an experienced health care professional or physical therapist.

Medications may provide some relief, but are not recommended for long-term use. Meclizine is often prescribed for persistent vertigo symptoms, and may be effective. Benzodiazepine medications like Valium are also effective but may cause significant drowsiness as a side effect. Other medications may be used to decrease nausea or vomiting. It is should be recognized that medications can provide symptomatic relief, but are not considered “cures” for vertigo. Many cases of vertigo resolve spontaneously within a few days.

Can Vertigo Be Prevented?
Controlling risk factors for stroke may decrease the risk of developing central vertigo. This includes making sure that blood pressure, cholesterol, weight, and blood glucose levels are in optimal ranges. To decrease symptoms of vertigo in cases of Meniere’s disease, controlling salt intake may be helpful. If peripheral vertigo has been diagnosed, then performing vestibular rehabilitation exercises routinely may help prevent recurrent episodes.

As most cases of vertigo occur spontaneously, it is difficult to predict who is at risk; as such, complete avoidance or prevention may not be possible. However, maintaining a healthy lifestyle will decrease the risks of experiencing this condition.

In Conclusion…
Most patients with peripheral vertigo can find substantial relief with treatment; it has been suggested that the Epley maneuver in cases of BPPV can benefit as many as 90% of affected patients. Although recurrence of BPPV may be more than 15% in the first year after an episode, it is unlikely that vertigo will persist beyond a few days. When vertigo persists, evaluation for any underlying structural problems of the brain, spinal canal, or inner ear may be necessary.

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