What is it, symptoms and causes
edited by Prof. Eugenio Mira – Otolaryngologist – Columbus Clinic Center
About Vertigo
Vertigo is the false sense that you or your surroundings are spinning or moving. In most cases, it is a prevalent symptom arising from damage to the peripheral, central or vestibular system. 95% cases in which vertigo has a peripheral origin.
The vestibular apparatus is a specific sense organ, whose parts (saccule, utricle, semicircular canals) are located in the inner ear. It is implicated in spatial sensitivity, in the perception of head and body position, in the regulation of muscle tone – eyes, neck, trunk, limbs – contributing to the sense of balance and distinct vision during head movements.
Peripheral vertigo: from symptoms to causes
| TRIGGERING FACTORS | There is a triggering factor (specific head movements) | Sudden vertigo without triggering factors | Sudden vertigo without triggering factors | Vertigo without triggering factors |
| FREQUENCY | It occurs whenever there is a triggering factor | Attacks are recurrent | A single isolated attack is experienced | Attacks are recurrent |
| DURATION | It is intense and usually lasts about ten seconds | Each episode lasts from half an hour to 6-7 hours | The attack lasts a few days (3-4) during which the symptoms gradually decrease | Each episode lasts for several hours |
| NYSTAGMUS rapid involuntary eye movement | Performing specific maneuvers the doctor can provoke the nystagmus which may vary according to the origin | A horizontal-torsional spontaneous nystagmus occurs, suppressed by fixation | A horizontal-torsional spontaneous nystagmus occurs, suppressed by fixation | Nystagmus is absent or may occur in various forms |
| GENERAL SIGNS AND SYMPTOMS | Not present | Nausea and vomiting, auditory symptoms (buzzing, “plugged” ears, hearing loss) | Nausea and vomiting | Sensitivity to noise and light, often associated or alternated with headache episodes |
| POSSIBLE CAUSES | BENIGN PAROXYSMAL POSITIONAL VERTIGO | MÉNIÈRE’S DISEASE | VESTIBULAR NEURITIS | MIGRAINE-ASSOCIATED VERTIGO |
Clinical features
Benign paroxysmal positional vertigo (cupololithiasis or canalithiasis)
It is caused by the detachment of small crystals (otoliths) which are normally fixed in a part of the vestibular labyrinth and which send information to the brain about the head position in the space. Once detached, due to many different reasons (from a trauma to an infection), these particles are inappropriately displaced into the semicircular canals, thus causing the classic symptoms.
Ménière’s Disease
It is thought to be caused by a temporary increase in pressure of the endolymph (fluid contained in the inner ear), due to multiple and largely unknown factors.
Vestibular Neuritis
This condition, also improperly called labyrinthitis, is associated with a reactivation of a latent herpes simplex virus, which notoriously runs its course and then goes dormant in the nerve only to flare up again at any time, often after a period of stress.
Migraine-Associated Vertigo
It can be associated with migraine or occur as a migraine equivalent. It affects more women than men and it often runs in families.
Diagnosis
It is mainly based on the assessment of the symptoms reported by the patient and on the vestibular examination. The latter consists of a series of tests including the observation of the patient’s eyes through particular glasses (Frenzel glasses), or alternatively through a more sophisticated system of infrared video-oculoscopy. In this way, both involuntary (such as nystagmus) and voluntary movements (such as slow and fast rhythmic movements) are monitored.
If a patient is suspected of benign paroxysmal positional vertigo, it is necessary to carry out a so-called positional test, which consists of resting the patient in bed and performing simple head movements to understand where the “fragments” have fallen.
In some cases, more detailed tests may be useful (from audiometry exam tests, to CAT and MRI).
Treatment
The treatment depends on what has caused the vertigo.
In the case of benign paroxysmal positional vertigo, the treatment is based on the execution of repositioning maneuvers (such as the Epley Maneuver or Semont Maneuver). Briefly, these involve moving and rotating the patient’s head in such a way that the small crystals which have ended up in the wrong place move out to settle where they cause less trouble and dissolve over time.