What is vertigo and what types are there?
In the medical sense, vertigo is defined as a perceived false motion between itself and the environment. Dizziness can be a symptom of a harmless and treatable disease, but it can also be the first symptom of a dangerous circulatory disorder in the brain. Since dizziness is often experienced with severe anxiety, psychological factors may also contribute.
Vertigo is a type of balance disorder that can itself be classified clinically into 3 types:
- Positional vertigo
- Prolonged spontaneous vertigo
- Relapsing vertigo
We call it peripheral vertigo if it is caused by a disturbance of the vestibulo-auricular apparatus. If the cause of vertigo is due to a brain lesion (cerebral infarction, epilepsy, multiple sclerosis, etc.), it is a vertigo of central origin.
What are usually the causes of the onset of vertigo?
The most common form is benign paroxysmal paroxysmal positional vertigo, which is a basically harmless form, but often not properly diagnosed. The origin of this dizziness lies in the organ of balance. Small calcifications in the inner ear enter the wrong place in the balance organ, in the vestibular system in the inner ear, and provide false signals to the brain in interdependence with rapid head movements. Dizziness is usually triggered by sudden movements of the head, such as waking up or getting out of bed in the morning.
The most frequent cause of spontaneous prolonged vertigo is an inflammation of the vestibular nerve called “vestibular neuronitis”, which causes an imbalance between both organs of balance and provokes a state of continuous dizziness with the sensation of turning to one side.
Vertigo is often accompanied by tinnitus (tinnitus), a noise heard only by the patient. In this case, it is probably a fistula in the vestibulo-auricular apparatus, Menière’s disease.
A circulatory disorder in the brain stem can also cause vertigo, but it is usually accompanied by other symptoms such as speech disturbance, unilateral weakness, visual or sensory disturbance.
Both migraine and epilepsy may present with episodic vertigo, which usually appears during the migraine or epileptic seizure.
Finally, multiple sclerosis may present with vertigo and dizziness, depending on the lesions in the brainstem.
What are the most common symptoms?
The most common symptom of vertigo is the subjective sensation of movement of surrounding objects or of the person’s own body; in many cases dizziness is accompanied by nausea and even vomiting.
In addition, postural instability and, usually, gait deviation with eyes closed (Unterberger’s sign) are observed.
What tests should a patient undergo in order to make a correct diagnosis?
A neurological examination is performed first, including a clear examination of the cranial nerves, especially ocular motility, which is usually influenced by the vestibulo-ocular reflex. Through special “Frenzel” glasses, small spontaneous or provoked eye movements can be observed, which we call Nystagmus. If the examination is typical of a lesion of the vestibular system without signs of involvement of the rest of the brain, we speak of peripheral vertigo and imaging studies are not usually necessary.
In case of ear involvement, an audiometry with the Otorhinolaryngology service is recommended.
If the symptoms point to a central origin, a neuroimaging study by MRI or cranial CT is usually indicated. In addition, a vascular study by Doppler is usually performed in order to objectify the cerebral circulation.
What treatments are available to treat vertigo?
If the clinical picture is correctly interpreted, the therapy of benign postural vertigo is not complicated. With a special sequence of body movements and rotations, the “ear stones” can be brought back to their original position. Most of the time, the dizziness disappears quickly. It is one of the simplest, cheapest and most effective measures in medicine, which unfortunately is still too rarely used.
In case of vestibular neuronitis, treatment usually consists of cortisone treatment to reduce nerve inflammation.
Ménière’s disease usually requires ENT treatment, while all types of central vertigo usually require neurorehabilitation if caused by a brain lesion.