Vertigo
Vertigo should be distinguished from pre-syncope, as both are frequently referred to as 'dizziness'.
Vertigo is a sense of spinning, which is worse when the head is moving. Ask people "is the room spinning, or are you spinning?"
- nausea and vomiting
- ataxia
- nystagmus
- worse with head movement
Causes
Peripheral vertigo - associated with sensory loss and tinnitus, suggesting problems with cranial nerve VIII
- Peripherally vertiginous people tend to have more severe symptoms
Central vertigo - associated with problems in CN VIII, vestibular nuclei, connections within the brainstem, or cerebellum
Symptoms are often continuous but less severe
- brain tumours
- stroke
- multiple sclerosis
intensity temporal pattern onset nystagmus nausea/vomit hearing loss neuro deficits |
peripheral moderate-intense brief, intense abrupt rotary/horizontal common possible none |
central mild-moderate chronic, continuous gradual any kind/vertical uncommon unlikely often present |
benign paroxysmal positional vertigo (BPPV)
comes and goes lasts for seconds or minutes
related to position of head
possibly caused by free-floating particles in the inner ear
fixed with Epley maneuvers
Halpike maneuver
- acute vestibular failure
- more....
Meniere's disease
quite rare
recurrent attacks of vertigo lasting hours
associated tinnitus, hearing loss, aural pressure
possibly caused by endolymphatic hydrops, with mixing of endolymph and perilymph
vertigo with migraine
labarynthitis
combination of sensorineural hearing loss and vertigo
Investigations
Complete physical exam
- vitals (including postural hypotension)
- neuro exam
cardiac