Vertig : Causes and treatment

Vertigo is not a disease but a symptom of balance disorder which can be due to any number of causes. It is defined as an “illusion” or “hallucination” of movement. It is the feeling that you or your environment is moving or spinning when there is no actual movement.

vertigo
Dizziness and imbalance are common causes of visit to primary health care physician and includes a broad range of sensations from severe vertigo to momentary lightheadedness. Vertigo is most common cause of referral to otolaryngology clinic.

Vertigo should not be confused with other terms related to imbalance like lightheadedness, unsteadiness, or drop attacks.


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Vertigo is not fear of heights

Even today vertigo is confused as fear of heights (Acrophobia—meaning Dizzy feeling often experienced when looking down from a high place), which is not true vertigo.

“Alfred Hitchcock’s” movie “Vertigo” (1958) shows its lead character a San Francisco detective (James Stewart) has Acrophobia but people confused it with vertigo because of the name of the movie.

Mild Vertigo is very common, and the symptoms are not usually serious. Most patients who experience vertigo have disorder of the vestibular system.

Normal Balance requires

  • Accurate sensory information from eyes, inner ear and proprioceptors (Muscles and joints)
  • Co ordination of information by brain (brain stem and cerebellum)
  • Normal motor output to muscles and joints

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Resulting in movement of head and neck, legs, eyes and rest of the body to maintain the balance and have clear vision while person is moving.

Vertigo is caused by

conflict of information between inner ear and other sensory system or defect in central integration of vesitbular information in brain.

I. Causes of vertigo
Vertigo may be because of otologic, neurologic, or systemic reasons. Cause can often be diagnosed by patient’s description of the problem and thorough physical examination; other tests are sometimes needed

Causes of Otologic Vertigo
  • Benign paroxysmal positional vertigo
  • Meniere’s disease
  • Vestibular neuritis and related conditions
  • Bilateral vestibular loss (about 1%)
  • SCD and Fistula (rare)
  • Chronic otitis media
  • Eustachian tube dysfunction (the tube that links the inner ear with the space behind the nose)
Central (Neurologic) Causes of Vertigo
  • Multiple sclerosis
  • Tumor (Acoustic neuroma)
  • Vascular causes
  1. Transient Ischemic Attacks or stroke
  2. Vasculitis: SLE, PAN, Temporal arteritis
Systemic causes of Vertigo
  • Anaemia (Low Hemoglobin)
  • Hypogycemia
    (Low Blood sugar)
  • Hypotension (Low Blood Pressure)
  • Drugs- Medicines such as salicylates, quinine and aminoglycosides
  • Viral Infection
II. Benign paroxysmal positional vertigo
III. Meniere’s disease
IV. Acute peripheral vestibulopathy
V. Superior canal dehiscence syndrome (SSC

Psychogenic vertigo

Anxiety disorder, hyperventilation and depression can manifest as chronic vertigo. Reassurance and counseling, cognitive behavioral therapy and medication are useful.

Trauma induced Vertigo

Head trauma -By direct injury to the labyrinth or by canalith dislodgement

Barotrauma- sudden atmospheric pressure changes (such as in pilots or divers) may cause perilymphatic fistula. Fistula usually heals in 2 weeks time with appropriate with bed rest and avoidance of straining and coughing. Surgical repair is required if there is progressive hearing loss.
Most disorders of the balance system are self-limiting and can be satisfactorily managed if the clinical tests and investigations point to a specific disorder but when the clinical tests and investigations point to vestibular disturbance of unknown etiology management becomes challenging task due to large number of potential underlying conditions. In theses cases Treatment for vertigo is mainly symptomatic with Reassurance to the patient, Physical therapy ,medicines. and sometimes surgery.

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