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Vertigo

The symptom of “vertigo” suggests the illusion of movement, typically spinning, rocking or rotating. Vertigo may be isolated, or associated with other symptoms. It may also be related to position changes (especially of the head and neck) or unrelated to  movement or positioning. It may emanate from the inner ear or the brain, typically the posterior fossa. The most common inner ear cause is “benign paroxysmal peripheral vertigo” (BPPV), due to misplaced detritus or “canaliths”, typically presenting as a chronic, intermittent, mild perception of spinning dizziness, associated with changes in head position, often provoked by turning over in bed or getting out of bed in the morning.  With a severe attack, prostration and nausea/vomiting may be seen. CNS causes include  stroke, intracranial hemorrhage, brain tumor, head trauma, migraine, epilepsy, and other conditions. It is, of course, very important to distinguish BPPV from “central” causes such as TIA or stroke.

Typical diagnostic tests may include brain imaging such as MR or CT, evoked potentials and EEG. However, a diagnosis may commonly be made at the time of the clinical evaluation without specific additional testing.

Treatment options depend on the ultimate diagnosis. For BPPV, common treatment options include vestibular suppressant medication (for a short period of time), avoidance measures such as careful movements and sleeping with the head of the bed elevated, and a form of physical therapy called “vestibular rehabilitation.” Sometimes, a bedside maneuver (Dix-Hallpike or canalith repositioning) may be effective.