Doctor's Notes on Vertigo
Vertigo is the sense that you or your environment are moving or spinning in circles. It’s considered to be one type of dizziness. It has been described as feeling like the world is spinning around you. One way to imagine vertigo is the sensation you get after spinning rapidly in circles for a period of time. These symptoms of vertigo occur even if you are standing still but typically get worse when moving the head. Nausea and vomiting are associated symptoms that can occur with vertigo.
Vertigo usually happens as a result of problems within the inner ear, which regulates the body’s sense of balance. Benign paroxysmal positional vertigo (BPPV) occurs when small crystals or stones normally found within the inner ear become displaced. Inflammation of the inner ear due to infection or other causes and fluid buildup within the inner ear (known as meniere’s Disease) are other common causes.
Vertigo implies there is a sensation of motion either of the person or the environment, often perceived as if the room is spinning around you. This should not be confused with symptoms of lightheadedness or fainting. Vertigo differs from motion sickness in that motion sickness is a feeling of being off-balance and lacking equilibrium, caused by repeated motions such as riding in a car or boat.
- If true vertigo exists, symptoms include a sensation of disorientation or motion. In addition, the individual may also have any or all of these symptoms:
- nausea or vomiting,
- sweating, and/or
- abnormal eye movements.
- The duration of symptoms can be from minutes to hours, and symptoms can be constant (chronic) or episodic. The onset may be due to a movement or change in position. It is important to tell the doctor about any recent head trauma or whiplash injury as well as any new medications the affected individual is taking.
- The person may have hearing loss and a ringing sensation in the ears.
- The person might have visual disturbances, weakness, difficulty speaking, a decreased level of consciousness, and difficulty walking.
Vertigo can be caused by problems in the brain or central nervous system (central vertigo) or the inner ear (peripheral vertigo). Vertigo is a symptom of other conditions and is not in itself contagious.
- Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the brief sensation of motion lasting 15 seconds to a few minutes. This may be described as a sudden attack of vertigo. It may be initiated by sudden head movements or moving the head in a certain direction, such as rolling over in bed. This type of vertigo is rarely serious and can be treated.
- Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular neuritis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. The most common cause of labyrinthitis is a viral or bacterial inner ear infection. The duration of symptoms can last for days until the inflammation subsides. Viruses that may cause labyrinthitis or vestibular neuritis include herpes viruses, influenza, measles, rubella, mumps, polio, hepatitis, and Epstein-Barr virus (EBV).
- Meniere's disease is composed of a triad of symptoms including episodes of vertigo, ringing in the ears (tinnitus), and hearing loss. People with this condition have the abrupt onset of severe vertigo and fluctuating hearing loss as well as periods in which they are symptom-free. The cause of Meniere's disease is not fully understood but is thought to be due to viral infections of the inner ear, head injury, a hereditary factors, or allergies.
- Acoustic neuroma is an uncommon cause of vertigo related to a type of tumor of the nerve tissue of the inner ear that can cause vertigo. Symptoms may include vertigo with one-sided ringing in the ear and hearing loss.
- Vertigo can be caused by decreased blood flow to the base of the brain. A blood clot or blockage in a blood vessel in the back of the brain can cause a stroke (cerebral vascular accident or CVA). Another type of stroke consisting of bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed. The result is that the person's eyes gaze away from the side with the problem. Walking is also extremely impaired.
- Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose.
- Head trauma and neck injury may also result in vertigo, which usually goes away on its own. Cervical vertigo can be caused by neck problems such as impingement of blood vessels or nerves from neck injuries.
- Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache, although not always. There is often a prior history of similar episodes but no lasting problems.
- Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can lead to lowered blood flow to the brain, causing vertigo symptoms.
- Changes in hormones during pregnancy along with low blood sugar levels can cause pregnant women to feel dizziness or vertigo, especially during the first trimester. In the second trimester, dizziness or vertigo may be due to pressure on blood vessels from the expanding uterus. Later in pregnancy dizziness and vertigo may be caused by lying on the back, which allows the weight of the baby to press on a large vein (vena cava) that carries blood to the heart.
- Anxiety or panic attacks may also cause people to feel the sensation of vertigo. Stress may worsen symptoms, though it usually does not cause them.
- Mal de Debarquement, which means "sickness of disembarkation," is the medical term for the dizziness and vertigo felt after travel by ship or boat. This is commonly felt after a cruise. In some cases people experience this sensation after getting out of a plane, car, or train.
A balance disorder is a condition that makes you feel unsteady or dizzy, as if you are moving, spinning, or floating, even though you are standing still or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.