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Have you ever felt the room spinning after getting up suddenly? That truly unsettling feeling is known as vertigo. Loss of balance and orientation are worrying symptoms that significantly interfere with daily life activities. This blog delves deeper into the causes, mechanisms, diagnostic approaches, and available treatment options for vertigo.
What is Vertigo?
Vertigo is a form of dizziness. It is characterized by a false feeling of spinning or rotation. Patients feel as if either they or their surroundings are spinning, making them feel off-balance and unsafe.
Many people confuse vertigo with dizziness. However, there is a difference between the two. Dizziness refers to physical weakness, where the person feels tired and lightheaded, whereas vertigo is a rotational or spinning sensation. Vertigo symptoms usually include issues with balance, nausea, hearing problems (ringing ears, hearing loss, fullness), headache, motion sickness, diplopia (double vision), slurred speech, and nystagmus (uncontrolled and involuntary to-and-fro or swinging movement of the eyes).
The symptoms of vertigo present the same way in both genders, albeit with some variations. Symptoms of vertigo in women are more pronounced due to hormonal fluctuations, and they commonly suffer from anxiety, nausea, and migraines. Men, on the other hand, have less frequent but more abrupt onset of vertigo symptoms. They are more prone to balance issues.
Types of Vertigo
Based on its underlying causes, vertigo is classified into two types:
Central Vertigo
Central vertigo is the more severe and less common of the two types of vertigo. The term “central” means that its cause stems from an issue in the central nervous system like a stroke, traumatic injury, or an infection. Central vertigo symptoms are more severe and debilitating compared to peripheral vertigo. Patients suffer from loss of balance and instability during walking.
Peripheral Vertigo
Peripheral vertigo is the more common type. The symptoms of peripheral vertigo are less severe comparatively. The cause is usually related to the ear (inner ear, vestibular centers). Inner ear diseases like Labyrinthitis, Vestibular Neuritis, BPPV - Benign Paroxysmal Positional Vertigo, Meniere’s Disease, etc., present with vertigo among other symptoms.
What Causes Vertigo?
Many conditions may present with vertigo or have vertigo as part of their symptoms. Common causes of vertigo are as follows:
Headache
Migraine headaches can distort signals to the brain areas concerned with balance like the brain stem, cerebellum, etc. They also cause fluctuations to the blood supply to these areas triggering a spinning or rotating sensation.
Stroke
A stroke is defined as poor blood flow to an area of the brain, leading to cell/tissue damage. If a stroke involves the brain stem, vestibular pathways, or the cerebellum, it causes vertigo associated with neurological signs such as nausea, slurred speech, diplopia, etc.
Traumatic Injury
Traumatic injury of the inner ear, vestibular nerve, brain stem, cerebellum, etc., can trigger vertigo and balance issues, among other associated signs and symptoms.
Infections
Infections of the inner ear and brain involving the areas that control balance and spatial orientation, like the brain stem, cerebellum, the vestibular labyrinth or nerve, etc., lead to vertigo. These infections may include meningitis, encephalitis, vestibular neuritis, labyrinthitis, etc.
Vestibular Migraine
Unlike a typical migraine, vestibular migraine is limited to the vestibular system that controls balance and orientation. Even though it is considered a type of migraine, it may or may not be associated with a headache. Vestibular migraine vertigo symptoms include loss of balance and dizziness.
Ménière’s Disease
This disease is limited to the ear, and symptoms occur due to the accumulation of fluid in the middle ear cavity. It is characterized by vertigo, instability while walking, and loss of hearing.
BPPV
BPPV stands for Benign Paroxysmal Positional Vertigo. It is a very common cause of unexplained vertigo symptoms. BPPV occurs because calcium particles get dislocated and float in the inner ear.
Shingles
Shingles is a very common viral infection that most of us have had once in life. It can be a cause of vertigo symptoms because the virus produces inflammation of the vestibular area in the ear.
Growths
Benign or malignant growths of the inner ear or brain are another frequent cause of vertigo symptoms. Examples include Acoustic Neuroma, Otosclerosis, etc.
How do Healthcare Providers Diagnose Vertigo?
The most effective and long-lasting way to alleviate vertigo is to get to the underlying cause and treat it. Healthcare providers begin the process of diagnosing vertigo by taking a detailed history and performing a thorough physical examination.
Diagnostic Tests/Investigations For Vertigo Symptoms
Some of the common tests and investigations employed by healthcare providers for the diagnosis of symptoms of vertigo include:
Vestibular Tests
This group of tests is performed to evaluate the vestibular area. It is also a way to differentiate between central and peripheral vertigo symptoms.
Romberg’s Test
A Romberg test is another effective way to find out if the cause of vertigo lies in the brain or the ear. The patient is directed to close their eyes and stand with arms and feet together. In case of a loss of balance, the cause is likely to be in the brain or spinal cord.
Fukuda Unterberger Test
This test is performed by asking the patient to walk in one place with eyes closed for 30 seconds. Rotating or leaning to one side during the test points towards an inner ear-related cause for vertigo symptoms.
Head Impulse Test
A healthcare provider suddenly moves the patient’s head to one side while the eyes are focused on a target. In normal people, the eyes stay on target. For people having vertigo due to a vestibular cause, the eyes will follow the direction of the head first and then spring back to the initial position (a Saccade).
CT/MRI Scans
CT or MRI scans are performed to rule out structural abnormalities, growths, fluid build-up, etc., in the brain and ear.
How Do You Get Vertigo to Go Away on Its Own?
Relief from vertigo symptoms on its own may not always be possible, but for mild vertigo causes like BPPV, the following actions may help resolve dizziness:
Improving hydration status
Getting proper rest
Vestibular exercises
Being conscious of and avoiding possible triggers
Allowing the brain time to adapt and compensate
If the vertigo doesn’t go away or is associated with other symptoms, a visit to a healthcare provider is a must.
