Vertigo

WHAT IS VERTIGO?

Vertigo is a symptom and not a disease. It is a type of dizziness which consists of an illusion of movement of the body or of the environment. The sense of movement is most often rotatory (i.e. spinning), but may also be a to-and-fro or up-and-down movement (e.g. like being on a boat), or a sense of veering to one side on walking, or being pulled to one side as though with a strong magnet. Often vertigo is associated with nausea, vomiting, and unsteadiness on walking.

Vertigo is a frequent complaint and a common cause of referral to a neurologist.

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What are the causes?

Causes of vertigo can be divided into peripheral causes (to do with the vestibular system – the labyrinth in our inner ears and the vestibular nerve which connects it to the brain) and central causes (to do with the brainstem and cerebellum). Some peripheral causes of vertigo are acute labyrinthitis or vestibular neuronitis, benign positional vertigo, Meniere’s disease, head trauma, stroke affecting the labyrinth, drugs and toxins, and acoustic neuroma. Central causes of vertigo include brainstem and cerebellar strokes, multiple sclerosis, migraine and epilepsy.

How is it diagnosed?

Patients presenting with vertigo should be assessed by a doctor to ascertain the cause of the vertigo. Often physical examination with manoeuvres to elicit vertigo in certain head positions can clinch the diagnosis, e.g. in benign positional vertigo. Sometimes ancillary tests are necessary such as MRI of the brain and vestibular apparatus, or specialized vestibular function tests (e.g. electronystagmography) and/or hearing tests.

What are the treatment options?

Treatment depends on the underlying cause of the vertigo. Vestibular suppressant drugs can be useful in the short term. One of the commonest causes of vertigo, benign positional vertigo, can respond dramatically to specific repositioning manoeuvres or vestibular rehabilitation. Meniere’s disease may respond to a diuretic or a very low salt diet. Vestibular migraine should be treated with antimigraine drugs.

What is the prognosis?

Prognosis also depends on the underlying cause. Peripheral causes of vertigo are usually self-limiting but can sometimes be incapacitating. The prognosis for vertigo caused by brain lesions such as stroke or multiple sclerosis depends on the amount of damage to the brain.