Causes and explanation of vertigo and instability

Vertigo and instability are frequent symptoms especially in the population over 65 years old. They constitute a cause of disability making mobility difficult, being also a cause of traumatisms.

Why do we have vertigo?

Inside the temporal bone of the skull there is an apparatus designed to “feel” continuously how our head moves, as it is very important for balance, this device has very important connections with structures of the nervous system related to eye movement. While it is working properly we are not aware that it exists nor of the importance of the information it sends to our nervous system. But when this information is not sent, an involuntary, rotating movement of the eyes is produced, which causes a sensation of movement of objects.

Causes of vertigo

The most frequent cause of vertigo is the so-called benign positional vertigo, which is closely related to head movements and is due to an obstruction in a conduit of the balance apparatus. But sometimes it occurs due to virus infections, or has vascular causes. Sometimes the lesions that cause vertigo are in the nervous system related to the balance apparatus.

What are its symptoms?

The most striking symptom, which usually frightens the patient considerably, is the intense and abrupt rotatory sensation that makes it difficult to maintain balance and is often accompanied by nausea and sometimes vomiting. Instability is also frequent, and when it is severe it is impossible to stand upright. The exact diagnosis is often difficult and the causative disease is not always found. Fortunately, the most common causes are very unpleasant but benign and have an easy solution; others present more complex diagnostic and therapeutic challenges.

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It is important to arrive at an accurate diagnosis in order to apply the appropriate treatment. In most cases the diagnosis is reached with the description of the symptoms explained by the patient and the vestibular examination, but sometimes it is necessary to resort to tests such as MRI or vestibular tests to make an accurate diagnosis.


Often it is solved with maneuvers called repositioning that are carried out in the same consultation. In other cases it is necessary to add antivertiginous drugs, or to proceed with exercises to reduce vertigo.


The continuous instability produces a great insecurity in the patient who suffers it, the problems to stand up if it is constant is translated in a great discomfort in the displacements, changes of level, going up and down stairs.

Causes of instability

It may be related to a dysfunction of the balance apparatus, and then it is often associated with episodes of vertigo, but sometimes not. In others the causes can be varied, from agoraphobia, to degenerative diseases of the cerebellum, to side effects of drugs, bilateral vestibular lesions, or diseases in which the rebalancing reflexes are altered. This obliges the neurologist to make an exhaustive exploration and studies, MRI, complex analysis, or other tests to be able to give a correct diagnosis and the appropriate treatment for each case.