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Vertigo

Overview

Vertigo is the illusory perception of movement, which is a sensory disorder. It is the cardinal symptom of a vestibular disorder, which is the area of the inner ear responsible for integration gall of the sensory stimuli we see, hear, and feel with regard to head and body movement. The sensation experience includes:

• Spinning
• Sense of tumbling or galling
• Ground rolling beneath one's feet
• Difficulty to focus visually or to keep one's eyes open during an attack
• Heart palpitations, sweating, nausea, and vomiting are also common accompanying factors

When this dysfunction occurs in the vestibular system, peripherally by damage to semicircular canals, saccule and utricle or centrally as is the case of a tumor. The conflict arises between signals sent to the brain by the vestibular system, and other balancing-sensing systems of the body.

The vertigo that results is a sensation of motion where there is no motion or an exaggerated sense of motion in response to a given bodily movement.

This condition is most commonly associated with persons over 50 years of age and the incidence increases proportionally with age. Benign Paroxysmal Vertigo is one of the most frequent syndromes accounting for about 16,000 new cases per year. BPV is relatively harmless - usually last about 8 seconds or less. The symptoms develop suddenly, occur intermittently, and may be severe enough to induce vomiting. These are usually precipitated by a change of the head in relation to gravity such as:

• Getting out of bed
• Rolling over
• Bending down
• Looking up while standing

Fundamentally, the most common pathological occurrence is when the otoliths in the utricle, held together by a gelatinous matrix, become dislodged. (Due to age related degeneration, head trauma or viral infections) These dislodged otoliths accumulate in the posterior semi-circular canal and block the flow of fluid.

The most important feature is typical nystagmus while assuming certain head positions. The nystagmus is of short duration (3-30seconds) rotational vertigo. (Relative absence of spontaneous symptoms without head movement or positional change)

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Symptoms

• Sensation of disorientation or motions
• Nausea/vomiting
• Sweating
• Abnormal eye movements
• Hearing loss/ringing noise
• Difficulty speaking
• Difficulty walking

*This is not a complete list and if you are experiencing these symptoms it is not guaranteed you have Vertigo.

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Treatment

Lifestyle Adaptations

• Use two or more pillows at night
• Avoid sleeping on effected side
• Get up slowly in the morning; also sit on edge of bed before getting up
• Avoid bending to pick up items or extending head
• Be careful when doing anything where you are lying on your back

Canalith Repositioning Procedure

1. Put pillow under shoulders
2. Turn head 45 degrees to affected side
3. Hold position for 30 seconds keeping head in that position, with shoulders on pillow and head back
4. Turn head 90 degrees to opposite side without raising head
5. Hold for 30 seconds
6. Turn your head and body 90 degrees in the same direction
7. Hold position for 30 seconds
8. Sit up
9. Do not lie down for at least 24 hours so debris can settle

Known Causes Of Vertigo

• Endolymphatic Hydrops (Meniere's disease)
• Syphilis
• Head trauma
• May respond to diuretics and low-salt diet
• Characterized by episodic vertigo (1-8 hours low-frequency sensorineural hearing loss, often fluctuating tinnitus and a sensation of aural pressure.)

Labyrinthitis

Vertigo is accompanied by hearing loss and tinnitus. Recovery usually lasts several weeks (hearing may be permanently impaired). Often follows an upper respiratory infection.

Vestibular Neuronitis

Usually Vertigo without disruption of hearing nystagmus and absence to caloric stimulation may occur. May have symptoms for several weeks.

Traumatic Vertigo

Concussion of the Labyrinth with trauma. Basilar skull fractures that traverse the inner ear may last in symptoms for several days to weeks and be associated with deafness. Chronic post-traumatic vertigo may occur when detached otoconia settle on the ampulla of posterior semi-circular canal (Rx: Surgical Repair)

Cervical Vertigo

This is due to cervical proprioception dysfunction. Usually occurs after neck injury (hypertension). Symptoms may be triggered by assuming a certain head positions rather moving to a new head positions (Rx: Neck movement exercises)

Central Nervous System Dysfunction

• Brain Stem Vascular Dysfunction
• Arteriovenous Malformation
• Tumor of the Brain-Stem and Cerebellum
• Multiple Sclerosis

Vertebro-Basilar Migraine

This form is often unremitting and disabling. Often other signs of brainstem dysfunction are cranial neuropathy, cerebellar deficits, or increased intracranial pressure.

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