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vertigo Definition Vertigo is a type of dizziness or a sensation of movement when none is actually occurring. What is going on in the body? People with vertigo either feel they are spinning or rotating abnormally. They may feel that the objects around them are spinning. This condition is not exactly the same as dizziness. Dizziness is more general term for feeling off balance. Vertigo is usually caused by problems in the inner ear, which helps control balance. It can also be caused by problems with the nerves or parts of the brain that receive and send signals to the ear. What are the signs and symptoms of the condition? When someone describes symptoms of vertigo, the healthcare provider will want to know: when the symptoms started how long the vertigo lasts what makes the symptoms better or worse, such as lying flat or standing up whether the symptoms came on gradually or suddenly whether the vertigo is constant or only occurs for a few minutes at a time what medications the person takes if the person has other medical problems Other symptoms that may be important include: difficulty walking, known as ataxia fainting headache hearing loss ringing in the ear, known as tinnitus visual impairments, such as blurred vision speech impairment, including slurred speech or difficulty finding the right word vomiting weakness in one part of the body What are the causes and risks of the condition? Vertigo has several causes, including: alcohol dependence antibiotics, such as gentamicin benign positional vertigo. This is brought on by certain positions, usually lying flat with the head turned in one direction. disturbances in the function of the inner ear balance structures. This may occur in a condition called Meniérè's disease. head injury infections of the inner ear, such as acute labyrinthitis migraine headache motion sickness multiple sclerosis, a degenerative nerve disorder phenytoin, a medication used to treat seizures psychological conditions, such as severe anxiety salicylate medications, including aspirin seizures, or abnormal electrical activity in the brain stroke, which occurs when a part of the brain doesn't get enough oxygen transient ischemic attack, which is similar to a stroke but lasts only a brief time trauma, or injury, to the inner ear structures brain tumors that affect the nerve or part of the brain associated with balance Other causes are also possible. Sometimes, no cause can be found. What can be done to prevent the condition? Most vertigo cannot be prevented. Avoidance of long-term alcohol dependence can prevent cases due to drinking alcohol. How is the condition diagnosed? Diagnosis of vertigo begins with a history and physical exam. Further tests may be needed. For example, a cranial CT scan or cranial MRI may be ordered if a stroke or brain tumor is suspected. A brain stem auditory evoked response test (BAER) may be used to check for a tumor. What are the long-term effects of the condition? Vertigo can keep people from engaging in normal activities. They may be more likely to fall and injure themselves. Or they may simply be unable to get out of bed or drive. Often the most serious long-term effects are related to the cause. For example, benign positional vertigo often goes away on its own and almost never has any long-term effects. A stroke, on the other hand, can cause other serious disabilities. A brain tumor may cause brain damage or even death. What are the risks to others? Vertigo is not contagious and poses no risk to others. If the underlying cause is an infection, the infection is sometimes contagious. What are the treatments for the condition? During an acute attack of vertigo, the person is advised to lie flat on a firm surface and focus on a fixed point. He or she should avoid eating or drinking, which may bring on an episode of vomiting. After the vertigo gets better, the person will probably be tired and need to sleep. Medications used to treat vertigo are tailored for each person but may include: calcium channel blockers, such as verapamil, flunarizine/cinnarizine, and nimodipine. These medicines dilate the small blood vessels of the inner ear. diuretics, such as triamterene/hydrochlorothiazide. These medications help excrete excess fluid from the body. medications that suppress the activity of the inner ear. This group includes lorazepam, meclizine, diazepam, and clonazepam. Steroids, such as prednisone, are used occasionally to treat vertigo. Medications that suppress the immune system, such as methotrexate, are used rarely. For individuals whose symptoms are infrequent, chronic medications may be too much. It may be best to treat the attacks as they occur. For those with more frequent attacks, diuretics can be useful. A person with vertigo may also be advised to follow a special diet. The hydrops diet focuses on limiting the intake of sodium and sugar. This diet also includes restrictions on excess intake of caffeine, alcohol, and monosodium glutamate (MSG). MSG is found in Chinese foods and some prepackaged foods. Destructive procedures are sometimes necessary for frequent, untreatable spells of vertigo. These procedures can take the form of surgery or medications. Surgery includes removal of the entire inner ear. This procedure can be helpful, particularly in individuals who have lost their hearing. In those who still have reasonable levels of hearing, the balance nerve can be cut. Certain antibiotics that are toxic to the ear can also be used. When placed in high doses behind the eardrum, they can destroy portions of the inner ear. A choice must be made between deafness and a certain amount of permanent imbalance. Benign positional vertigo may come and go over a period of weeks or years. For this type, healthcare providers may try a canalith repositioning procedure. While lying on the back, the person extends the head over the end of a table. He or she then turns the head to one side, rolls over onto that side, and returns to a sitting position. This is an attempt to move tiny particles around inside the middle ear. Individuals should consult their healthcare provider before using this technique. What are the side effects of the treatments? Medications used to treat vertigo commonly cause drowsiness and dry mouth. Surgery carries a risk of bleeding, infection, hearing impairment, and allergic reaction to anesthesia. Calcium channel blockers have long been used to treat vertigo as well as high blood pressure. However, the findings of two recent studies show that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medications for high blood pressure. The findings of one study, for example, showed that the risk of heart attack was 27% greater. The risk of congestive heart failure was 26% higher. The American Heart Association recommends discussing the risks and benefits of the medication with a healthcare provider. What happens after treatment for the condition? If the vertigo goes away or the cause is under control, no further treatment may be needed. Benign positional vertigo often goes away on its own within a few months. Other causes may need further treatment, such as a brain tumor or a stroke. How is the condition monitored? People with vertigo can monitor their symptoms at homer. The cause may need further monitoring. For example, those with seizures may need blood tests to monitor the therapeutic drug level of medications. Any new or worsening symptoms should be reported to the healthcare provider.

Author: Adam Brochert, MD Date Written: 06/15/00 Reviewer: Eileen McLaughlin, RN, BSN Date Reviewed: 08/06/01 Potential conflict of interest information for reviewers available on request