Vertigo is a type of dizziness that gives a person the sensation of spinning round and round, when no such movement is actually occurring.
What is going on in the body?
People with vertigo either feel they are spinning or rotating abnormally. They may feel that the objects around them are spinning. This condition is different from other types of dizziness. Dizziness is more general term for feeling off balance, and is often also described as lightheadedness.
Vertigo is usually caused by problems in the inner ear, which helps control balance. It can also be caused by problems with the nerves or parts of the brain that receive and send signals to the ear.
What are the causes and risks of the condition?
Vertigo has several causes, including:
antibiotics, such as gentamicin
benign positional vertigo. In this condition, the symptom is brought on when the individual is in certain positions, usually lying flat with the head turned in one direction.
disturbances in the function of the inner ear balance structures. This may occur in a condition called Meniérè's disease.
infections of the inner ear, such as acute labyrinthitis
multiple sclerosis, a degenerative nerve disorder
phenytoin, a medication used to treat seizures
psychological conditions, such as severe anxiety
salicylate medications, including aspirin
seizures, or abnormal electrical activity in the brain
stroke, which occurs when a part of the brain does not get enough oxygen
transient ischemic attack, which is similar to a stroke but lasts only a brief time
trauma, or injury, to the inner ear structures
- brain tumors that affect the nerve or part of the brain associated with balance
Other causes are also possible. Sometimes, no cause can be found.
What can be done to prevent the condition?
Most vertigo cannot be prevented. Avoidance of long-term alcohol dependence can prevent cases due to drinking alcohol.
How is the condition diagnosed?
Diagnosis of vertigo begins with a history and physical exam. Further tests may be needed. For example, a cranial CT scan or cranial MRI may be ordered if a stroke or brain tumor or other central process is suspected. A brain stem auditory evoked response test (BAER) may also be used to check for a tumor.
Long Term Effects
What are the long-term effects of the condition?
Vertigo can keep people from engaging in normal activities. They may be more likely to fall and injure themselves, or they may simply be unable to get out of bed or drive. Often the most serious long-term effects are related to the cause. For example, benign positional vertigo often goes away on its own and almost never has any long-term effects. A stroke, on the other hand, can cause other serious disabilities. A brain tumor may cause brain damage or even death.
What are the risks to others?
Vertigo is not contagious and poses no risk to others. If the underlying cause is an infection, the infection is sometimes contagious.
What are the treatments for the condition?
During an acute attack of vertigo, the person is advised to lie flat on a firm surface and focus on a fixed point. He or she should avoid eating or drinking, which may bring on an episode of vomiting. After the vertigo gets better, the person will probably be tired and need to sleep.
Medications used to treat vertigo are tailored for each person but may include:
calcium channel blockers, such as verapamil (i.e., Calan, Covera, Isoptin, Verelan), flunarizine (i.e. Sibelium), cinnarizine (i.e, Stugeron, Mitronal), and nimodipine (i.e. Nimotop). These medicines dilate the small blood vessels of the inner ear.
diuretics, such as triamterene/hydrochlorothiazide (i.e. Dyazide). These medications help excrete excess fluid from the body.
- medications that suppress the activity of the inner ear. This group includes lorazepam (i.e., Ativan, meclizine (i.e., Antivert), diazepam (i.e., Valium), and clonazepam (i.e., Klonopin).
Steroids, such as prednisone (i.e. Sterapred), are used occasionally to treat vertigo. Medications that suppress the immune system, such as methotrexate (i.e., Trexall, Rheumatrex), are used rarely. For individuals whose symptoms are infrequent, chronic medications may be too much. It may be best to treat the attacks as they occur.
For those with more frequent attacks, diuretics can be useful. A person with vertigo may also be advised to follow a special diet. The hydrops diet focuses on limiting the intake of sodium and sugar. This diet also includes restrictions on excess intake of caffeine, alcohol, and monosodium glutamate (MSG). MSG is found in Chinese foods and some prepackaged foods.
Destructive procedures are sometimes necessary for frequent, untreatable spells of vertigo. These procedures can take the form of surgery or medications. Surgery includes removal of the entire inner ear. This procedure can be helpful, particularly in individuals who have lost their hearing. In those who still have reasonable levels of hearing, the balance nerve can be cut.
Certain antibiotics that are toxic to the ear can also be used. When placed in high doses behind the eardrum, they can destroy portions of the inner ear. Sometimes a choice must be made between deafness and a certain amount of permanent imbalance.
Benign positional vertigo may come and go over a period of weeks or years. For this type, healthcare professionals may try a canalith repositioning procedure. While lying on the back, the person extends the head over the end of a table. He or she then turns the head to one side, rolls over onto that side, and returns to a sitting position. This is an attempt to move tiny particles around inside the middle ear. Individuals should consult their healthcare professional before using this technique.
What are the side effects of the treatments?
Medications used to treat vertigo commonly cause drowsiness and dry mouth. Surgery can be complicated by bleeding, infection, hearing impairment, or reactions to anesthesia.
Calcium channel blockers have long been used to treat vertigo as well as high blood pressure. However, the findings of two recent studies show that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medications for high blood pressure. The findings of one study, for example, showed that the risk of heart attack was 27% greater. The risk of congestive heart failure was 26% higher. The American Heart Association recommends discussing the risks and benefits of the medication with a healthcare professional.
What happens after treatment for the condition?
If the vertigo goes away or the cause is under control, no further treatment may be needed. Benign positional vertigo often goes away on its own within a few months. Other causes may need further treatment, such as a brain tumor or a stroke.
How is the condition monitored?
People with vertigo can monitor their symptoms at homer. The cause may need further monitoring. For example, those with seizures may need blood tests to monitor the therapeutic drug level of medications. Any new or worsening symptoms should be reported to the healthcare professional.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.
Mayo Clinic Health Letter and Mayo Clinic Family Health Book