Vertigo-associated disorders

• Causes, incidence, and risk factors

  There are two types of vertigo:

  • Peripheral vertigo occurs if there is a problem with the part of the inner ear that controls balance (vestibular labyrinth or semicircular canals) or with the vestibular nerve, which connects the inner ear to the brainstem.
  • Central vertigo occurs if there is a problem in the brain, particularly in the brainstem or the back part of the brain (cerebellum).

  Vertigo related to the inner ear may be caused by:

  • Benign positional vertigo (also called benign paroxysmal positional vertigo)
  • Drugs called aminoglycoside antibiotics
  • Injury (such as head injury)
  • Labyrinthitis
  • Ménière's disease

  Vertigo related to the vestibular nerve may be caused by:

  • Inflammation (neuronitis)
  • Nerve compression (usually a noncancerous tumor such as a meningioma or schwannoma)

  Vertigo related to the brainstem may be caused by:

  • Blood vessel disease
  • Drugs (anticonvulsants, aspirin, alcohol)
  • Migraine
  • Multiple sclerosis
  • Seizures (rarely)
• Symptoms

  The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms from the condition causing the vertigo. Symptoms can include:

  • Difficulty swallowing
  • Double vision
  • Eye movement problems
  • Facial paralysis
  • Slurred speech
  • Weakness of the limbs

  The spinning sensation may cause nausea and vomiting in some people.

• Signs and tests

  A physical exam may reveal:

  • Eye movement problems, involuntary eye movements (nystagmus)
  • Lack of coordination and balance, difficulty walking
  • Hearing loss
  • Weakness

  Tests to determine the cause of vertigo may include:

  • Blood tests
  • Brainstem auditory evoked potential studies
  • Caloric stimulation
  • EEG
  • Electronystagmography
  • Head CT
  • Lumbar puncture
  • MRI scan of head and MRA scan of blood vessels of the brain
• Treatment

  Medications to treat peripheral vertigo may include:

  • Anticholinergics (such as scopolamine)
  • Antihistamines (such as meclizine)
  • Benzodiazepines (such as diazepam or lorazepam)
  • Promethazine (to treat nausea and vomiting)

  Benign positional vertigo is most often treated with physical maneuvers that help reposition small structures in the semicircular canals of the inner ear. This reduces or stops the vertigo.

  The cause of central vertigo should be identified and treated as appropriate.

  Try to avoid head positions that cause vertigo. Use caution in situations such as driving, walking, or operating heavy equipment. Even short episodes of vertigo may be dangerous.

• Expectations (prognosis)

  The outcome depends on the cause.

• Complications

  Persistent, unrelieved vertigo can interfere with driving, work, and lifestyle. It can also cause falls, which can lead to many injuries, including hip fractures.

• Calling your health care provider

  Call for an appointment with your health care provider if vertigo is persistent or troublesome.

• References

  Baloh RW. Hearing and equilibrium. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 454.

  Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, et al., eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005; chap 126.

Review Date: 10/30/2008

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.