Vertigo – Causes, Symptoms, Treatment, Diagnosis

The Facts

Vertigo is a condition in which you feel off-balance and dizzy, as if you or your surroundings are moving, spinning, or swaying. It can lead to nausea and disability. Vertigo is most common in elderly people, but it can affect both sexes at any age. It may be a temporary or permanent condition. Vertigo is especially problematic when symptoms occur during a task such as driving or operating machinery.

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Causes

The organ of balance is the vestibular system in the ear, a tiny grid of fluid-filled tubes and sacs. There are two identical vestibular systems, located in the labyrinth of each inner ear. As you move, the liquid in the tubes also moves about, and its levels are read by nerve cells. The information is sent to the brain, which uses it to calculate which way is down and what should be the horizontal level.

Any problems with balance originate in the vestibular system, so people who suffer from frequent vertigo are said to have a vestibular disorder. Balance problems may be associated with a ringing in the ears or loss of hearing. Vertigo can also be caused by changes in the parts of the brain (cerebellum and brain stem) that are also involved in controlling balance.

Major causes of vertigo include the following:

• benign paroxysmal positional vertigo: This is a common form of vertigo, usually brought on by specific head positions or movements. It is caused by calcium deposits in the inner ear balance organ that periodically become dislodged and cause symptoms.
• head trauma: People who have received a violent blow on the head can suffer temporary or permanent damage to the inner ear, causing balance problems.
• vestibular neuritis: This is also known as vestibular neuronitis and labyrinthitis, and is believed to be caused by a viral infection. It affects the nerves of the vestibular system and not the cochlea (the organ for hearing). However, neuritis can also be caused by a blood clot lodged in the tiny blood vessels that feed the inner ear.
• Ménière’s disease: This was once called watchmaker’s disease because it tends to strike people who do precise, intricate work that requires concentration and careful control of the hands for long periods. Nobody knows what causes Ménière’s disease.

Some antibiotics can damage the vestibular system in high doses or with prolonged use. Acetylsalicylic acid* (ASA), caffeine, alcohol, nicotine, sedatives, tranquilizers, and several illegal drugs can cause temporary dizziness but do no permanent damage to the balance organs once they are stopped.

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Symptoms and Complications

Vertigo is the primary symptom of any balance disorder. If you close your eyes during an episode of vertigo, you’ll feel as if you’re spinning or falling. Severe vertigo can cause vomiting and stop you from walking.

Because the vestibular system is linked to the brain’s movement centre and to the eyes, some people with vestibular disorders find their vision is affected, or their muscles are poorly coordinated or don’t go where they’re supposed to. The muscles may ache, particularly in the neck and back.

Some people complain of other symptoms during attacks of vertigo, like memory problems or difficulty reading. Most people find the struggle against vertigo physically exhausting. Symptoms can last from a few minutes to hours.

The symptoms of bacterial labyrinthitis are unmistakable. Typically, an ear infection will be followed over days or weeks by a serious deterioration of hearing and extreme vertigo. Viral labyrinthitis may appear weeks or months after a bout of flu or some other viral illness. The vertigo is milder and you may not lose any hearing, though you’ll probably have tinnitus, a ringing in the ear.

Ménière’s disease brings periodic attacks of vertigo and tinnitus, ranging in frequency from once a year to once a day. Hearing may come and go, but it tends to get worse over the long run. About 10% to 15% of people with Ménière’s disease have it in both ears.

Neuritis due to a blood clot causes sudden loss of balance that may leave you unable to walk for weeks. Your hearing may be unchanged.

See your doctor right away if your vertigo symptoms occur with head or neck pain, fainting, or are severe and continue for over an hour.

Making the Diagnosis

Many diseases can cause dizziness, especially diseases that involve poor circulation and low blood pressure. The first step of a diagnosis is a complete medical checkup, including testing oxygen and blood sugar levels.

Audiometry is a thorough test of various hearing abilities. A device that measures eye movements in various situations, an electronystagmograph, provides clues about the nature of the problem. In platform posturography, you stand on a movable platform and your responses to movement are recorded.

Treatment and Prevention

Many cases of vertigo, even severe vertigo, such as in labyrinthitis, clear up on their own, but it usually takes time. Depending on the cause of the vertigo, a doctor may recommend any number of treatments, ranging from antibiotics, antihistamines, and other medications to surgery. Your doctor may also prescribe a medication to help with nausea and vomiting. The doctor may also suggest some exercises that help to build tolerance to vertigo, making episodes less intense and shorter.

For benign paroxysmal positional vertigo , there is an effective treatment called the particle repositioning maneuver. Your doctor or therapist may perform this series of head movements on you during an acute attack, then teach you how to do the movements yourself should the attack recur. There are several commercially available aids to help you do this maneuver correctly.

If vertigo is due to motion sickness or a certain type of movement, it can be prevented by avoiding the trigger or by using a technique called visual fixation, where you can help prevent vertigo by fixing the eyes on a specific point on the horizon.

Rehabilitation programs can also help people with vestibular damage to recover their balance and coordination and overcome vision problems.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Vertigo

A woman with severe vertigo with nausea, vomiting, tinnitus

A 42-year-old woman is evaluated for occasional episodes of severe vertigo with nausea,
vomiting, tinnitus, and a feeling of ear fullness. Her first episode occurred 3 years
ago, and since then, she has had approximately six episodes, each of which may last
from a few hours to 1 or 2 days. Meclizine and diazepam taken at the onset of symptoms
provide partial relief, but she often must resort to bed rest during these episodes,
missing 1 to 2 days of work. She has a family history of migraine headache, although
the patient does not experience headache or visual symptoms with her episodes of dizziness.

Physical examination, including vital signs, is normal. An audiogram discloses a bilateral
low-frequency sensorineural hearing loss. MRI of the head is normal.

Which of the following is the most likely diagnosis in this patient?

A. Acephalgic migraine
B. Ménière’s disease
C. Acoustic neuroma
D. Benign positional vertigo
E. Vestibular neuritis

Reveal the Answer

Answer and critique

Ménière’s disease is the most common cause of recurrent, disabling
attacks of vertigo. Age of onset occurs most commonly in the fourth to sixth decade
of life. Episodes typically last for several hours and are accompanied by vomiting
and cochlear symptoms (for example, tinnitus, ear fullness, and/or hearing loss).

Episodes occur at irregular intervals over years, and patients may develop a progressive
sensorineural hearing loss, initially unilateral and low-frequency in nature, but
eventually bilateral in 30% to 50% of patients. Prior to identifying changes in an
audiogram, the diagnosis of Ménière’s disease is largely established
clinically without the necessity of diagnostic testing. Treatment for acute episodes
of this disorder is symptomatic and includes meclizine, benzodiazepines, antiemetics,
and for frequent recurrences is prophylactic, requiring diuretics and a low-sodium
diet because the presumptive pathophysiology involves increased endolymphatic fluid
volume. Because spontaneous remission occurs frequently in long-term follow-up, endolymphatic
shunting or other surgical treatments are reserved for a minority of patients.

Acephalgic migraine is a controversial diagnosis and a rare cause of vertigo in large
series of dizzy patients. Migraine is a difficult diagnosis to establish in the absence
of headache or classic visual or other prodromal features and would not be associated
with abnormal audiometry results.

Acoustic neuroma is a very rare tumor in which the usual symptoms are a slowly progressive
unilateral hearing loss with or without tinnitus. Severe vertiginous attacks are not
the usual presentation for acoustic neuromas, and MRI of the internal auditory canal
and adjacent structures can identify most of these tumors.

Benign positional vertigo is characterized by brief (less than 1 minute) episodes
of vertigo triggered by changes of head position and not associated with vomiting
or prostration.

Vestibular neuritis is typically a single episode of disabling vertigo that resolves
in a few days to a week and, although it may occasionally be recurrent, is rarely
manifested by the chronic, episodic course or the progressive hearing loss associated
with Ménière’s disease. An acute episode of dizziness resembling vestibular
neuritis but associated with a unilateral hearing loss typically is referred to as
labyrinthitis.

Key Points

• Episodes of Ménière’s disease last for several hours and involve vomiting
  and cochlear symptoms, and patients may develop a progressive sensorineural hearing
  loss.
• Prior to identifying changes in an audiogram, the diagnosis of Ménière’s
  disease is largely established clinically without the necessity for diagnostic testing.

Dizziness, Vertigo, and Imbalance: Background, Etiology, Epidemiology

Author

Hesham M Samy, MD, PhD Associate Professor of Audiovestibular Medicine, Minia Unversity, Egypt

Hesham M Samy, MD, PhD is a member of the following medical societies: American Academy of Audiology, American Auditory Society, Association for Research in Otolaryngology, Egyptian Society of Otorhinolaryngology

Disclosure: Nothing to disclose.

Coauthor(s)

Mohamed A Hamid, MD, PhD Founder and Medical Director, The Cleveland Hearing and Balance Center; Clinical and Adjunct Professor of ENT, Case-MetroHealth, Medical College of Virginia, and Ain Shams University, Egypt

Mohamed A Hamid, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society, American Neurotology Society

Disclosure: Nothing to disclose.

Marc Friedman, DO, FAAN Consultant in Otoneurology, The Cleveland Hearing and Balance Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary’s Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD NW Neuro-Ophthalmology

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec and Genentech for participation on Advisory Boards.

Acknowledgements

Marc Friedman, DO Chief of Neurology, Parma Hospital, Consultant, Department of Neurology-Neurotology, Cleveland Hearing and Balance Center

Disclosure: Nothing to disclose.

Spiros Manolidis, MD Associate Professor of Otolaryngology and Neurological Surgery, Columbia University

Spiros Manolidis, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Head and Neck Society, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Benign Paroxysmal Positional Vertigo (BPPV) | CS Mott Children’s Hospital

Topic Overview

What is benign paroxysmal positional vertigo (BPPV)?

Vertigo is the feeling that you are spinning or the world is spinning around you. Benign paroxysmal positional vertigo is caused by a problem in the inner ear. It usually causes brief vertigo spells that come and go.

For some people, BPPV goes away by itself in a few weeks. But it can come back again.

BPPV is not a sign of a serious health problem.

What causes BPPV?

Benign paroxysmal positional vertigo (BPPV) is caused by a problem in the inner ear. Tiny calcium “stones” inside your inner ear canals help you keep your balance. Normally, when you move a certain way, such as when you stand up or turn your head, these stones move around. Sometimes these stones move into an area of your inner ear called the semicircular canal. When you move your head in certain ways, the stones in the semicircular canal move. Sensors in the semicircular canal are triggered by the stones, which causes a feeling of dizziness.

What are the symptoms?

The main symptom is a feeling that you are spinning or tilting when you are not. This can happen when you move your head in a certain way, like rolling over in bed, turning your head quickly, bending over, or tipping your head back.

BPPV usually lasts a minute or two. It can be mild, or it can be bad enough to make you feel sick to your stomach and vomit. You may even find it hard to stand or walk without losing your balance.

How is BPPV diagnosed?

Your doctor can usually tell that you have BPPV by asking you questions about your vertigo and doing a physical exam. You may have a test where your doctor watches your eyes while turning your head and helping you lie back. This is called the Dix-Hallpike test.

There are other things that can cause vertigo, so if your doctor doesn’t think you have BPPV, you may have other tests too.

How is it treated?

Your doctor can usually do one of two procedures in the office that works for most cases of BPPV. These procedures are called the Epley maneuver and the Semont maneuver. If you don’t want treatment or if treatment doesn’t work, BPPV usually goes away by itself within a few weeks. Over time, your brain will likely get used to the confusing signals it gets from your inner ear. Either way, you can do some simple exercises that train your brain to get used to the confusing vertigo signals.

Medicine may help with severe nausea and vomiting.

Be extra careful so that you don’t hurt yourself or someone else if you have a sudden attack of vertigo.

• Do not drive or cycle if there is any chance that vertigo could strike and make you lose control. (This depends on what kind of movement triggers vertigo for you.)
• At home, keep floors and walkways free of clutter so you don’t trip.
• Avoid heights.
• Don’t use tools or machines that could be dangerous if you suddenly get dizzy or lose your balance.

Cause

Benign paroxysmal positional vertigo (BPPV) is caused by a problem in the inner ear. Tiny calcium “stones” inside your inner ear canals help you keep your balance. Normally, when you move a certain way, such as when you stand up or turn your head, these stones move around. Sometimes these stones move into an area of your inner ear called the semicircular canal. When you move your head in certain ways, the stones in the semicircular canal move. Sensors in the semicircular canal are triggered by the stones, which causes a feeling of dizziness.

Symptoms

The main symptom of benign paroxysmal positional vertigo (BPPV) is the feeling that you or your surroundings are spinning, whirling, or tilting. This sensation is called vertigo.

It is important to understand the difference between vertigo and dizziness. People often use those two terms as if they meant the same thing. But they are different symptoms, and they may point to different problems.

• Vertigo is the feeling that you are spinning or the world is spinning around you. It happens when your body’s balance sensory systems disagree about what kind of movement they sense. You may find it hard to walk or stand. You may even lose your balance and fall. If your vertigo is bad enough, you may also have nausea and vomiting.
• Dizziness is not a feeling that you are spinning. It is a woozy or unsteady feeling.

To find out whether your vertigo is caused by BPPV, your doctor will want to find out what causes it, how bad it is, and how long it lasts. With BPPV:

• Tilting the head, looking up or down, rolling over in bed, or getting in and out of bed causes vertigo.
• It begins a few seconds after you move your head.
• It usually lasts less than a minute. The spinning sensation may be mild, or it may be bad enough to cause nausea and vomiting.
• Vertigo becomes less noticeable each time you repeat the same movement. After 3 or 4 repeats, the movement may no longer cause vertigo. Several hours may pass before the same movement again causes vertigo.

What Happens

Benign paroxysmal positional vertigo (BPPV) causes a whirling, spinning sensation even though you are not moving. If the vertigo is bad, it may also cause nausea or vomiting. The vertigo attacks happen when you move your head in a certain way, such as tilting it back or up or down, or by rolling over in bed. It usually lasts less than a minute. Moving your head to the same position again may trigger another episode of vertigo.

BPPV often goes away without treatment. Until it does, or is successfully treated, it can repeatedly cause vertigo with a particular head movement. Sometimes it will stop for a period of months or years and then suddenly come back.

What Increases Your Risk

Scientists think you’re more likely to develop benign paroxysmal positional vertigo (BPPV) if you have one of these conditions:

• You are an older adult.
• You have a head injury.
• You have an inflammation of the inner ear or of the nerve that connects the inner ear to the brain, a condition called vestibular neuritis.
• You have ear surgery.

If you’ve had one episode of vertigo caused by BPPV, you are likely to have more.

When should you call your doctor?

Call
911
or other emergency services immediately if you have vertigo (a spinning sensation) and:

• You passed out (lost consciousness).
• You have symptoms of a stroke, such as:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.
• You have chest pain.
• You have a headache, especially if you also have a stiff neck and fever.
• You have sudden hearing loss.
• You have numbness or tingling that does not go away, anywhere on your body.
• You have vomiting that doesn’t stop.
• You had a recent head injury.

Call your doctor now or seek immediate care if:

• You have an attack of vertigo that is different from those you have had before or from what your doctor told you to expect.
• You need medicine to control nausea and vomiting caused by severe vertigo.

Call your doctor to schedule an appointment if:

• This is the first time you have had an attack of vertigo.
• You have a low-pitched roaring, ringing, or hissing sound in your ear, especially if you have not had this before. This is called tinnitus.
• You have frequent or severe episodes of vertigo that interfere with your activities.

Watchful waiting

If your symptoms suggest benign paroxysmal positional vertigo (BPPV), watchful waiting may be appropriate. Over time BPPV may go away on its own. But treatment with a simple procedure in your doctor’s office (either the Epley or Semont maneuver) can usually stop your vertigo right away. Talk to your doctor. If your vertigo interferes with your normal daily activities or causes nausea and vomiting, you may need treatment.

Who to see

The following health professionals are able to diagnose and treat BPPV and the causes of vertigo:

Exams and Tests

Benign paroxysmal positional vertigo (BPPV) is diagnosed with a physical exam and your medical history. But diagnosing the cause of the spinning, whirling sensation of vertigo can be difficult. Several diseases, the side effects of medicines, and head injuries can also cause vertigo.

A Dix-Hallpike test may be done to help your doctor find out the cause of your vertigo. During this test, he or she will carefully observe any involuntary eye movements. This will help your doctor know whether the cause of your vertigo is inside your brain, your inner ear, or the nerve connected to your inner ear. The Dix-Hallpike test also can help your doctor find out which ear is affected.

If your symptoms or the results of your exam make your doctor think you don’t have BPPV, other tests may be done:

• Electronystagmography, which attaches small wires to your face that measure eye movements. It looks for the special eye movements that happen when the inner ear is stimulated. The pattern of eye movements can point to the location of the cause of the vertigo, such as the inner ear or the central nervous system.
• Imaging tests, such as magnetic resonance imaging of the head (MRI) or computed tomography of the head (CT scan). These tests may be done if the symptoms and exam findings could be caused by a brain problem.
• Hearing testing to detect hearing loss. A special hearing test can determine whether the nerve from the inner ear to the brain is working correctly. Hearing loss with vertigo usually points to a problem other than BPPV, such as Ménière’s disease or labyrinthitis.

Treatment Overview

Benign paroxysmal positional vertigo (BPPV) may go away in a few weeks by itself. If treatment is needed, it usually consists of head exercises (Epley and Semont maneuvers). These exercises will move the particles out of the semicircular canals of your inner ear to a place where they will not cause vertigo.

Over time, your brain may react less and less to the confusing signals triggered by the particles in the inner ear. This is called compensation. Compensation occurs most quickly if you continue normal head movements, even though doing so causes the whirling sensation of vertigo. A Brandt-Daroff exercise may also be done to speed the compensation process.

Medicines called vestibular suppressants (such as antihistamines, sedatives, or scopolamine) may be tried if your symptoms are severe.

Antiemetic medicines may also be used to reduce nausea and vomiting that can occur with vertigo.

In rare cases, surgery may be used to treat BPPV.

Prevention

In most cases, benign paroxysmal positional vertigo (BPPV) cannot be prevented. But some cases may result from head injuries. Wearing a helmet when bicycling, motorcycling, playing baseball, or doing other sports activities can protect you from a head injury and BPPV.

Home Treatment

You can reduce the whirling or spinning sensation of vertigo when you have benign paroxysmal positional vertigo (BPPV) by taking these steps:

• Use two or more pillows at night.
• Avoid sleeping on your side with the ear that’s causing the problem facing down.
• Get up slowly in the morning and sit on the edge of the bed for a moment before standing.
• Avoid leaning over to pick things up or tipping your head far back to look up.
• Be careful about reclining, such as when you are in the dentist’s chair or having your hair washed at a hair salon.
• Be careful about playing sports that require you to turn your head, lean over, or lie flat on your back.

You can also help yourself by doing balance exercises and taking safety precautions.

• Brandt-Daroff exercises can be done at home to help your brain get used to the abnormal balance signals triggered by the particles in the inner ear.
• Balance exercises for vertigo, such as standing with your feet together, arms down, and slowly moving your head from side to side, may help you keep your balance and improve symptoms of vertigo.
• Stay safe when you have balance problems by adding grab bars near the bathtub and toilet and keeping walking paths clear. This may prevent accidents and injuries.

Staying as active as possible usually helps the brain adjust more quickly. But that can be hard to do when moving is what causes your vertigo. Bed rest may help, but it usually increases the time it takes for the brain to adjust.

Medications

Medicines do not cure benign paroxysmal positional vertigo (BPPV). But they may be used to control severe symptoms, such as the whirling, spinning sensation of vertigo and the nausea and vomiting that may occur.

Medicine choices

Medicines to reduce the whirling sensation of vertigo are called vestibular suppressants. They include:

• Antihistamines, such as meclizine (Antivert).
• Scopolamine (Transderm-Scop).
• Sedatives, such as clonazepam (Klonopin).

Antiemetic medicines, such as promethazine (Promethegan), may be used if you have severe nausea or vomiting.

What to think about

Medicines that calm the inner ear (vestibular suppressants) may also slow down the brain’s ability to adjust to the abnormal balance signals triggered by the particles in the inner ear. They should be taken only to control severe symptoms.

Surgery

Ear surgery is an option for treating benign paroxysmal positional vertigo (BPPV) only in severe cases when other treatments have not worked.

Other Treatment

Exercises are used to treat benign paroxysmal positional vertigo (BPPV). These exercises help the particles in the semicircular canals of your inner ear move around, so that they don’t cause vertigo. Although the exercises usually stop the vertigo for months or years, the problem may return and cause your symptoms to come back.

Other treatment choices

Exercises that may be used to treat BPPV include:

• Epley maneuver and Semont maneuver. These exercises often cure BPPV by moving the particles in your inner ear so that they do not affect your balance. During these exercises, your doctor will help you hold your head in a series of positions. Often, one treatment is enough. You may be taught to do these exercises on your own at home.
• Brandt-Daroff exercise. This exercise may be tried if the Epley or Semont maneuvers do not work. During this exercise, you will repeatedly go from a sitting position to a lying position until the vertigo stops. This exercise may help speed your brain’s ability to adjust to the conflicting balance signals it is getting. You need to do these exercises several times a day for weeks for them to work.

What to think about

These exercises can get rid of BPPV symptoms. The Epley and Semont maneuvers usually are more comfortable than the Brandt-Daroff exercise, and they work faster—in one or two treatments rather than being repeated several times a day for weeks. So these maneuvers have become the first line of treatment.^{footnote 1}

References

Citations

1. Fife TD, et al. (2008). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 70(22): 2067–2074.

Other Works Consulted

• Hillier SL, McDonnell M (2011). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews (2).
• Hilton M, Pinder D (2004). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
• Johnson J, Lalwani AK (2012). Vestibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 729–738. New York: McGraw-Hill.
• Kerber KA (2011). Episodic vertigo. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 210–213. Philadelphia: Saunders.
• Von Brevern M, et al. (2006). Short-term efficacy of Epley’s manoeuvre: A double-blind randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry, 77(8): 980–982.
• Walker MF, Daroff RB (2015). Dizziness and vertigo. In DL Kasper et al., eds., Harrison’s Principles of Internal Medicine, 19th ed., vol. 1, pp. 148–151. New York: McGraw-Hill Education.

Credits

Current as of:
December 2, 2020

Author: Healthwise Staff
Medical Review:
Anne C. Poinier MD – Internal Medicine
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine

Current as of: December 2, 2020

Author:
Healthwise Staff

Medical Review:Anne C. Poinier MD – Internal Medicine & Kathleen Romito MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine

Vertigo | Health Navigator NZ

Vertigo is a feeling of dizziness that you or your surroundings are moving or spinning. The feeling may be brief and barely noticeable, or severe, making daily tasks difficult.

Key points about vertigo

1. With vertigo, you may be unsteady, have difficulty walking or standing, and may lose your balance.
2. There are many causes of vertigo, but they are mainly due to problems with your inner ear.
3. Common causes include benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuronitis or labyrinthitis.
4. The treatment for vertigo depends on the cause and severity of your symptoms.
5. There are some things you can do to help prevent vertigo, such as avoiding situations that can trigger your symptoms.
6. It is also important not to drive if you are having vertigo attacks or are feeling dizzy.

What are the symptoms of vertigo?

Vertigo is a sensation of dizziness that comes from feeling that you or your surroundings are moving when there isn’t actually any movement. Some people describe it as the room spinning around, or a feeling of falling or tilting. You may be unsteady, have difficulty walking or standing, and may lose your balance. Vertigo can start suddenly and may vary in intensity. It may stay or come and go.

You may also have other symptoms along with vertigo, including:

• nausea (feeling sick) and vomiting (being sick)
• tinnitus (ringing in your ears)
• impaired or reduced hearing
• ear pain or ear fullness.

Vertigo or lightheadedness?

Vertigo is not the same as lightheadedness. Lightheadedness is a feeling that you are going to faint or pass out. It is often caused by lack of oxygen to your brain rather than problems with your ear. When you say you have dizziness, your doctor will ask questions to work our whether you have vertigo or lightheadedness.

Note that nerve and muscle pressure around your neck and shoulder region may mimic vertigo.  

What are the causes of vertigo?

As well as sending sound waves to your brain so that you can hear, your inner ear helps to keep your balance when you turn your head, walk or even stumble. Vertigo is often caused by problems with your inner ear. 

The 2 types of vertigo, according to their cause, are peripheral and central.

Inner ear (peripheral) causes

Common causes of vertigo due to problems with your inner ear include:

Benign paroxysmal positional vertigo

• Benign paroxysmal positional vertigo is usually caused by sudden changes in the position of your head, such as when you tip your head up or down, when you lie down or when you turn over or sit up in bed.
• Vertigo tends to last for a minute or less and settles if you keep your head still.  
• This type of vertigo is usually caused by small calcium deposits in your inner ear, which move as you do.
• It can increase your risk of falls.
• It is not serious.

Vestibular neuronitis

• Vestibular neuronitis is the inflammation of the vestibular nerve, part of what is called the eighth cranial nerve.
• This nerve carries messages from your inner ear about head movement.
• When the nerve is inflamed or infected, the sensation of dizziness or vertigo arises.
• It’s usually caused by a viral infection.
• The vertigo may last from hours to days, usually improves within a week but but may last for several weeks. 
• Your hearing is not affected.

Meniere’s disease

• Meniere’s disease is a disorder of the inner ear where you get the feeling of vertigo and hearing loss, and possibly a feeling of pressure in your ears.
• It usually affects younger adults aged 20–50 years.
• The vertigo usually lasts from 1–24 hours, but may last for days.
• Tinnitus (ringing in your ears) is not uncommon.

Read more about Meniere’s disease.

Labyrinthitis

• Labyrinthitis usually affects adults between the ages of 30 and 60.
• It is inflammation of a part of your inner ear called the labyrinth, an organ including the cochlea and part of your balance mechanism.
• As well as vertigo, your hearing is impaired.
• It is usually caused by a common viral infection, such as measles or the flu, but can sometimes be caused by a bacterial infection.
• You may have fever (high temperature), nausea (feeling sick), vomiting (being sick) and tinnitus (ringing in your ears).

Tumour

A tumour in your inner ear can also cause vertigo, but this is rare.

Other causes (central causes)

Vertigo can be due to problems outside your inner ear, including:

Sometimes, the cause of vertigo is unknown.

How is vertigo diagnosed?

Your doctor will ask you about the symptoms of your vertigo and any other symptoms you may have, such as nausea or vomiting, hearing loss or ear fullness. As dizziness means different things to different people, your doctor may ask you to describe your symptoms to find out whether you have vertigo or lightheadedness.

Your doctor will also examine your ears and eyes, check your balance and your nerves. You may be referred to a ENT (ear, nose and throat) specialist for further tests if the cause is not clear.

These may include a hearing test and caloric testing, in which warm or cool water is introduced into your ear canal to see how your inner ear responds. A posture machine is sometimes used to note how your balance system is receiving messages from your eyes and joints.

How is vertigo treated?

The treatment for vertigo depends on the cause and severity of your symptoms.

Some medicines may be prescribed to relieve your symptoms, including:

Depending on the cause of your vertigo, your doctor may also recommend some special exercises that involve specific movements:

• The Epley manoeuvre involves head movements designed to move fragments of calcium into areas less likely to cause your symptoms.
• Brandt-Daroff exercise involves movement of your upper body.  
• Vestibular rehabilitation involves retraining your balance system not to respond to some messages your brain is receiving.

Very rarely, surgery may be needed to correct the cause of your vertigo.

How can I care for myself with vertigo?

Here are some things you can do at home to help prevent vertigo:

• Lie still in a quiet, darkened room – this may help to ease nausea and reduce the sensation of spinning.
• Avoid stressful situations – anxiety can make vertigo worse. Read more about how to deal with stress and anxiety.
• Avoid head movements or head positions that can trigger symptoms.
• Avoid sleeping on the affected side, if one side of your ear or head is more affected than the other.
• Raise your head on 2 pillows when resting.
• Get out of bed slowly and sit on the edge of the bed for a minute before standing up.
• Make sure your glasses are current, so you can avoid anything in your way.

How can I prevent accidents and falls with vertigo?

Because vertigo can affect your balance and may make you feel unsteady, you are at risk of falls or accidents.

To reduce your risk of a fall or accident:

• get out of a bed or chair slowly
• wear low-heeled shoes that fit properly
• use handrails on stairs
• install grab bars in the bathroom – don’t use towel racks for balance
• use a shower stool and apply adhesive strips to the shower or tub floor
• use a walking aid if needed
• let your employer know about your symptoms, especially if your job involves operating machinery or climbing ladders.

Vertigo and driving

If you have vertigo, it can be extremely dangerous to drive. It is important to let your doctor know so they can find out the cause of your vertigo and treat it accordingly.

It is also a legal requirement for you to drive only when you are medically fit, which means not to drive if you are dizzy or experiencing vertigo. You need to stop driving until your condition has been treated and you have no more attacks of vertigo.  

Learn more

The following links provide further information on vertigo. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Vertigo Ministry of Health NZ
Vertigo HealthInfo Canterbury, NZ
Vertigo Health Direct, Australia
Dizziness and vertigo Better Health Channel, Australia
Vertigo NHS, UK
Vertigo Patient Info, UK
Brandt-Daroff exercises NHS, UK

References

1. Vertigo Auckland Regional HealthPathways, NZ, 2019
2. A delicate balance: managing vertigo in general practice BPAC, NZ, 2012
3. An approach to vertigo in general practice Australian Family Physician, 2016

Reviewed by

	After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.

The following information on vertigo is taken from Auckland Regional HealthPathways, NZ, accessed March 2021:

About vertigo

Vertigo involves a false sensation that the patient or their surroundings are moving or spinning, usually accompanied by nausea and loss of balance. Causes of vertigo can be differentiated into:

• Central – involving cerebral cortex, cerebellum, brainstem e.g., cerebrovascular disease, migraine, multiple sclerosis, acoustic neuroma, diplopia, alcohol intoxication.
• Peripheral – involving vestibular labyrinth, semicircular canals, or vestibular nerve e.g., viral labyrinthitis, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), Ménière disease, motion sickness, ototoxicity.

Clinical guideline and resources

A delicate balance: managing vertigo in general practice BPAC, NZ, 2012
Vertigo Australian Family Physician, Australia, 2010
Dix-hallpike test Chicago Dizziness and Hearing, US, 2021
The Epley Maneuver (Canalith repositioning procedure) for BPPV Chicago Dizziness and Hearing, US, 2021
Medical aspects of fitness of drive NZ Transport Agency, NZ, 2014

New Zealand Formulary (NZF)

Drugs used in nausea and vertigo

Continuing professional development

Podcast

Vertigo – Melanie Collins Goodfellow Unit, 2017
“Melanie Collins talks about the management of vertigo in general practice. Melanie is an ENT surgeon at North Shore Hospital and at the ENT group at Mercy Hospital in Auckland.”

Videos

Positive head impulse test 

(Peter Johns, 2013)

eLearning

Vertigo BMJ Learning & The Royal New Zealand College of General Practitioners Modules

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: 

Dizziness: Lightheadedness and Vertigo | Cigna

Is dizziness your main problem?

How old are you?

3 years or younger

3 years or younger

4 to 11 years

4 to 11 years

12 years or older

12 years or older

Are you male or female?

Why do we ask this question?

• If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
• If your symptoms aren’t related to those organs, you can choose the gender you identify with.
• If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had a head injury?

Did you pass out completely (lose consciousness)?

If you are answering for someone else: Is the person unconscious now?

(If you are answering this question for yourself, say no. )

Are you back to your normal level of alertness?

After passing out, it’s normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.

Yes

Has returned to normal after loss of consciousness

No

Has returned to normal after loss of consciousness

Did the loss of consciousness occur during the past 24 hours?

Yes

Loss of consciousness in past 24 hours

No

Loss of consciousness in past 24 hours

Have you had any new neurological symptoms other than dizziness?

Yes

Other neurological symptoms

No

Other neurological symptoms

Do you have these symptoms right now?

Yes

Neurological symptoms now present

No

Neurological symptoms now present

Is the dizziness severe?

Severe means that you are so dizzy that you need help to stand or walk.

Have you had sudden, severe hearing loss?

Yes

Sudden, severe hearing loss

No

Sudden, severe hearing loss

Is vertigo a new problem?

Are your symptoms getting worse?

Yes

Dizziness is getting worse

No

Dizziness is getting worse

Did the symptoms start after a recent injury?

Yes

Symptoms began after recent injury

No

Symptoms began after recent injury

Have you recently had moments when you felt like you were going to faint?

Yes

Episodes of feeling faint

No

Episodes of feeling faint

Have you felt faint or lightheaded for more than 24 hours?

Yes

Has felt faint or lightheaded for more than 24 hours

No

Has felt faint or lightheaded for more than 24 hours

Are you nauseated or vomiting?

Nauseated means you feel sick to your stomach, like you are going to vomit.

Are you nauseated a lot of the time or vomiting repeatedly?

Yes

Persistent nausea or vomiting

No

Persistent nausea or vomiting

Do you think that a medicine could be causing the dizziness?

Think about whether the dizziness started after you began using a new medicine or a higher dose of a medicine.

Yes

Medicine may be causing dizziness

No

Medicine may be causing dizziness

Have you been feeling dizzy for more than 5 days?

Yes

Dizziness for more than 5 days

No

Dizziness for more than 5 days

Is the problem disrupting your daily activities?

Yes

Dizziness interfering with daily activities

No

Dizziness interfering with daily activities

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

• Your age. Babies and older adults tend to get sicker quicker.
• Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
• Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
• Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
• Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

• Try home treatment to relieve the symptoms.
• Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.

Symptoms of a heart attack may include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Symptoms of serious illness may include:

• A severe headache.
• A stiff neck.
• Mental changes, such as feeling confused or much less alert.
• Extreme fatigue (to the point where it’s hard for you to function).
• Shaking chills.

Heartbeat changes can include:

• A faster or slower heartbeat than is normal for you. This would include a pulse rate of more than 120 beats per minute (when you are not exercising) or less than 50 beats per minute (unless that is normal for you).
• A heart rate that does not have a steady pattern.
• Skipped beats.
• Extra beats.

Neurological symptoms—which may be signs of a problem with the nervous system—can affect many body functions. Symptoms may include:

• Numbness, weakness, or lack of movement in your face, arm, or leg, especially on only one side of your body.
• Trouble seeing in one or both eyes.
• Trouble speaking.
• Confusion or trouble understanding simple statements.
• Problems with balance or coordination (for example, falling down or dropping things).
• Seizures.

Many prescription and nonprescription medicines can make you feel lightheaded or affect your balance. A few examples are:

• Antibiotics.
• Blood pressure medicines.
• Medicines used to treat depression or anxiety.
• Pain medicines.
• Medicines used to treat cancer (chemotherapy).

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

• Passing out (losing consciousness).
• Feeling very dizzy or lightheaded, like you may pass out.
• Feeling very weak or having trouble standing.
• Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

• Call your doctor now to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care in the next hour.
• You do not need to call an ambulance unless:
  • You cannot travel safely either by driving yourself or by having someone else drive you.
  • You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

• Call your doctor today to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care today.
• If it is evening, watch the symptoms and seek care in the morning.
• If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

• Make an appointment to see your doctor in the next 1 to 2 weeks.
• If appropriate, try home treatment while you are waiting for the appointment.
• If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Head Injury, Age 4 and Older

Head Injury, Age 3 and Younger

New type of vertigo identified — ScienceDaily

Neurologists have identified a new type of vertigo with no known cause, according to a study published in the May 23, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.

With vertigo, people have episodes of dizziness that can last from minutes to days. Vertigo can be caused by serious conditions, such as tumors, or conditions that are fairly benign, such the inner ear disorder Meniere’s disease. But for some people, no cause can be found.

In this new study, neurologists have identified a new type of vertigo where treatment may be effective.

“These conditions can be difficult to diagnose and quite debilitating for people, so it’s exciting to be able to discover this new diagnosis of a condition that may respond to treatment,” said study author Ji-Soo Kim, MD, PhD, of Seoul National University in Seongnam, South Korea.

To diagnose this new condition, the person sits in a dark room and the examiner moves the patient’s head forward and then the head is shaken horizontally for about 15 seconds. Then the patient opens his or her eyes and a video recording is taken of eye movements. The neurologists discovered that after the test people with this new condition had eye movements called nystagmus that lasted longer than for other people. The new condition is called recurrent spontaneous vertigo with head-shaking nystagmus.

Among 338 people with vertigo with no known cause, 35 had this new condition and were included in the study. The participants had attacks of vertigo ranging from two or three times a week to once a year. They also experienced nausea or vomiting, headaches and intolerance of head motions during the attacks.

The participants were compared to 35 people with other conditions that can cause vertigo, such Meniere’s disease, vestibular migraine and vestibular neuritis. The test measured the time constant, or the time that represents the speed with which the reflexive eye movements can respond to change. For those with the new condition, the time constant during the primary phase of the nystagmus was 12 seconds, while it was six seconds for those with Meniere’s disease and five seconds for those with vestibular neuritis and vestibular migraine.

The neurologists also found that people with the new type of vertigo were more likely to have severe motion sickness than those with other types of vertigo.

A total of 20 of the 35 people with the new type of vertigo who had frequent attacks and severe symptoms were given preventive medication. About one-third of those had partial or complete recovery with the new medication. During the long-term follow-up of an average of 12 years after the first symptoms for 31 participants, five reported no more attacks, 14 said their symptoms had improved and only one said symptoms had gotten worse.

Kim said that people with this condition may have a hyperactive mechanism in their vestibular system that helps the brain respond to movement of the body and in the environment.

“It’s possible that the vertigo occurs when this unstable mechanism is disrupted by factors either within the person’s body or in their environment,” Kim said.

Story Source:

Materials provided by American Academy of Neurology. Note: Content may be edited for style and length.

90,000 causes in women – Treatment of dizziness with cervical osteochondrosis and pressure

Such unpleasant symptoms as severe dizziness, nausea and weakness can be companions of various neurological and other diseases. A person suffering from vertigo – this is what experts call dizziness – has the feeling that his body or objects located in the surrounding space are rotating. This may resemble a state of intoxication or motion sickness in transport, which is accompanied by lightheadedness.Each patient describes it differently.

Today, neurologists, together with their colleagues who specialize in other fields of medicine, have at least a hundred possible causes of dizziness. Many of them are combined, which makes the diagnosis and determination of the specific cause of the ailment even more difficult.

Causes of dizziness in women and men

Most often, the factors provoking the development of this unpleasant symptom are relatively harmless. It is enough for a person to go to bed late and get up early, do not have lunch on time or go for a river walk on a windy day, as weakness and dizziness with nausea can manifest themselves. However, they may indicate that the patient has a much more serious pathology.

Vertigo in women and men is divided into central and peripheral. In accordance with this classification, the former are provoked by disturbances in the functioning of the brain (all kinds of neoplasms, cerebral hemorrhages, etc. ).and the latter are caused by pathologies of the inner ear and / or vestibular apparatus.

According to another classification, headaches and dizziness can be systemic and non-systemic. At the same time, systemic ones are the result of a malfunction in one of the systems responsible for orientation in space: eyes, vestibular apparatus, etc. Non-systemic dizziness and weakness, in turn, can be triggered by insufficient intake of glucose (dieting), severe fatigue or prolonged stress, as well as motion sickness in transport, etc.d.

Headaches, dizziness and weakness can be symptoms of a number of diseases:

• stroke is often accompanied by severe vertigo, double vision, inability to express normally and other symptoms that cannot go unnoticed;
• severe dizziness and nausea – up to indomitable vomiting – are characteristic signs of a neurological disease such as Meniere’s disease;
• inflammation in the inner ear, which can also be accompanied by discharge from the ear canal and tinnitus;
• dizziness after the patient gives his body an upright position, may indicate the development of vestibular neuritis;
• dizziness with osteochondrosis becomes more pronounced with movement. Patients suffering from this disease are characterized by a wobbly, unsteady gait, headaches and muscle stiffness in the neck;
• paroxysmal vertigo can also be a sign that a patient has a neoplasm in the brain – benign or malignant – or a signal of an impending migraine attack;
• There are other causes of dizziness, which may include taking certain medications or injuries to the head and spine, dysfunction of the eye muscles and intoxication of the body.Only a specialist can identify what exactly became the cause and choose an effective treatment regimen.

In women, dizziness and weakness often appear during menstruation. As for elderly patients, this pathology may be the result of degenerative changes in various body systems – cardiovascular, vestibular, nervous, etc. In addition, visual impairments that inevitably occur with age can also be accompanied by such a phenomenon as vertigo.

Treatment of dizziness in the clinic “Wise Doctor”

In our medical center, much attention is paid to non-traditional treatment of diseases – osteopathy, acupuncture, manual therapy, etc. In order to get rid of dizziness, pills are not necessary at all – let’s talk a little about how our specialists work!

Osteopathy allows you to carefully relieve the patient of the cause of the development of vertigo, which may be completely unexpected at first glance.For example, severe dizziness tormenting the patient for a long time may be the result of diaphragm ossification and pathological curvature of the spine in the thoracic region. After the first session, the patient will feel relief, and the course of treatment with an osteopath will generally relieve him of painful attacks of dizziness and lightheadedness!

In addition, applied kinesiology successfully copes with various disorders of the functioning of organs and systems of the body.In the process of testing, a kinesiologist identifies the reasons for the development of pathology. Already after the first session, patients notice a decrease in the intensity of dizziness, and after the second or third session, they thank the specialist for a significant improvement in their well-being. Even in patients who have not left their homes for years due to the enormous discomfort associated with the disease, after a course of treatment with a kinesiologist, the state of health normal for people of their age is restored. Our specialists have already helped dozens of people to return to an active lifestyle and restore their ability to work!

Manual therapy and massage are very effective for getting rid of dizziness in osteochondrosis, as well as dizziness after neck injuries and other types of it.These techniques allow to restore cerebral blood supply and also eliminate such common neurological symptoms as tinnitus, neck pain, etc.

90,000 Dizziness? When should i see a doctor? – Into-Sana

Judge your health by how you enjoy the morning and spring – Henry David Thoreau

There is nothing better than springtime! This is a light breath of a fresh breeze, and the shine of young greenery, and the birth of a new life. When nature wakes up, everything around wakes up, you and I also “wake up”, we renew ourselves, new desires, new feelings and emotions appear. The world around us appears from its best side to our weary gaze of the monotony of winter – a clear blue sky, the smell of blooming gardens, lilac bushes strewn with fragrant bunches. The scent of spring makes the blood run faster through the veins. The heady feeling of renewal encourages us to be closer to nature. All of this makes the head spin … But sometimes for some reason, the dizziness lasts longer than desired, as if on a constantly spinning merry-go-round.

Each of us is probably familiar with this surreal feeling, as if the earth is leaving from under our feet, helicopters are flying in front of our eyes, the feeling of nausea is replaced by the feeling of rotation of our own body and surrounding objects in space. These are manifestations of the so-called “seasickness” or Vertigo.

Vertigo (from Lat. Dizziness) is a feeling of rotation of the person himself or the objects around him, accompanied by a violation of spatial orientation. True dizziness is often accompanied by vegetative symptoms – nausea, vomiting, excessive sweating.

The term “dizziness” is often misunderstood by patients. Basically, patients complain of a feeling of nausea, approaching loss of consciousness, “lightness in the head”, disorder of coordination, sensations after riding a carousel. Often, dizziness is also understood as an imbalance – instability, staggering when walking.

These complaints are characteristic of a light-headed state and are combined with pallor of the skin, accelerated heartbeat, nausea, darkening in the eyes, excessive sweating.Similar conditions are observed against the background of oxygen starvation of the brain.

In fact, the true sign of VERTIGO is the illusion of movement of the person himself or the picture he sees, and can be a symptom of a large number of diseases, including those that threaten the patient’s life. True dizziness is characteristic of damage to the vestibular system, which regulates the position and movement of the human body in space. It may indicate disorders in the peripheral (in the inner ear) or central (in the brain) parts of the vestibular system.

What should be mentioned at the doctor’s appointment?

• When does dizziness occur?
• What caused dizziness (change in atmospheric pressure, emotional or physical stress, premenstrual period, sharp turn of the head, change in body position from horizontal to vertical and vice versa)?
• What symptoms are accompanied by (nausea, tinnitus, increased blood pressure, increased sweating, headache, etc.)etc.)?
• What medications are you taking (some medications may make you dizzy)?
• Have you had any recent head and neck injuries (for example, the so-called whiplash – occurs in car accidents, when the head is suddenly tilted forward or backward when braking or hitting a car)?

Dizziness in combination with double vision and sensory disturbances in the face or limbs indicates a cause associated with impaired blood supply to the brain, the functioning of the central part of the vestibular system (central dizziness), while dizziness in combination with hearing complaints is usually associated with peripheral lesion (peripheral dizziness).The most common cause of dizziness is impaired blood flow in the vertebral arteries, which is characteristic of osteochondrosis of the cervical spine. This pathology is accompanied by dizziness that occurs when turning or tilting the head.

What diseases can cause dizziness?

Dizziness is observed in various diseases, among which the most common are:

• Meniere’s disease (ENT – pathology) – characterized by acute attacks of hearing loss, tinnitus and dizziness, often with a feeling of congestion in the affected ear;
• Labyrinthitis (ENT – pathology) inflammation of the inner ear (labyrinth), consisting of three semicircular canals – a frequent complication of otitis media;
• Post-traumatic dizziness;
• Neoplasms of the brain, middle ear, or auditory nerve;
• Dizziness with pathology of the cervical spine (spondylosis, osteochondrosis, instability of the vertebrae, Kimmerli’s pathology) – occurs due to compression of the vertebral arteries and oxygen starvation of the brain structures responsible for coordination;
• Cerebral circulation disorders (strokes) – develop against the background of atherosclerosis of the cerebral arteries, hypertension, diabetes mellitus, etc.;
• Vegeto-vascular dystonia (neurocirculatory dystonia). Dizziness is a consequence of changes in the blood supply of the vessels of the brain;
• Migraine (often, vertigo acts as a harbinger or “aura” of migraine).

Diagnostics

The main purpose of the diagnostic search for vertigo is to clarify its cause. The most common methods for examining the causes of vertigo are now ultrasound scanning of the vessels of the head and neck, magnetic resonance imaging, and X-ray of the cervical spine.

• Doppler ultrasound can assess vascular patency, detect atherosclerotic plaques, determine if there is sufficient blood flow to the brain, and if the outflow through the venous vessels is adequate. Transcranial Doppler ultrasound is a method for examining the vessels of the brain through the bones of the skull: it evaluates the tone of the vessels and makes it possible to diagnose the pathology of the vascular system of the brain. Ultrasound examination is relatively cheap, non-invasive, completely harmless and painless.The procedure for ultrasound scanning of the vessels of the head and neck lasts 35-40 minutes.
• Magnetic resonance angiography provides a very informative image of the vessels in the neck and brain. This study is mainly used to diagnose various anomalies of the vascular system (aneurysms, arteriovenous malformations, etc.). With this procedure, the patient is not exposed to radiation. However, magnetic resonance angiography is a complex and expensive test, so only a doctor should make the decision to perform it.
• X-ray of the cervical spine with functional tests allows you to determine the instability of the cervical vertebrae, Kimmerly’s anomaly (which will not show on MRI).
• MRI of the brain, and sometimes MRI of the cervical spine, help to make a definitive diagnosis.
• Consultation of an ENT doctor, tympanometry audiometry will allow to exclude ENT pathology.

First aid

Tip 1: If an attack of dizziness caught you unexpectedly, the first step is to calm down and try to avoid panic.If dizziness is not caused by motion sickness, try to focus on a specific object and keep your eyes open. In this case, it is worth sitting down or lying down, finding a comfortable position. Measure your blood pressure. With increased pressure, you should not try to immediately sharply reduce it. Remember: lowering blood pressure below normal in most cases is more dangerous than raising it.

Advice 2: Take a tablet of a sedative (at least valerian) and massage the reflex points located on the hands in the hollow between the thumb and forefinger.After an attack of sudden dizziness has occurred, you should consult a neurologist as soon as possible.

Advice 3: In case of acute dizziness, especially in combination with speech impairment, weakness or awkwardness in the arm or leg, double vision, numbness or other sensory disorders, you should immediately call an ambulance. In this case, you should not take any medication without talking to your doctor.

Remember that this problem should not be postponed for later.Do not think that it will resolve on its own – a delay will only aggravate your condition and can lead to serious complications. Do not self-medicate. It is not only ineffective in most cases, but can also cause significant damage to your health, promote the transition of the disease into a chronic form, and lead to late diagnosis of the disease.

Do not hesitate and do not be afraid to trust specialists, love yourself, take care of your health and enjoy life.Healthy people do it better than sick people.

Be healthy!

90,000 Why dizzy: useful news at panoramamed.ru

Complaining of dizziness, patients cannot always describe their condition. No wonder. Since vertigo has many causes, they manifest themselves in different ways.Pavel Repin, a neurologist at the Panorama Med medical center, tells how to distinguish between dangerous and safe dizziness.

– Pavel Nikolaevich, are there clear criteria for dizziness?

– Dizziness is a very capacious term, by which the patient can understand both dizziness itself and a feeling of unsteadiness, uncertainty when walking, a feeling of nausea. The illusion of rotation of objects, trees, people that surround the patient is characteristic.Feelings similar to riding on a merry-go-round in varying degrees of severity. But dizziness can be of another kind, when an emptiness is felt in the head, and weightlessness in the body, while it seems to a person that he is about to faint. This is also called dizziness. Sudden nausea, weakness, sweating, and a feeling of fear are other manifestations of dizziness. And a very common symptom is instability, loss of coordination. As you can see, this phenomenon has many characteristic features, and the causes of dizziness are even greater – from neurosis to cerebrovascular accident.

– How can you tell them apart?

– First of all, you need to know that dizziness can have a different nature. There are vestibular vertigo, which occurs due to a violation of the ratio of fluid in the structures of the inner ear. This type of dizziness is accompanied by impaired coordination of movements and a clear sensation of rotation in a certain direction. Vestibular vertigo is curable and is dealt with by neurologists and otolaryngologists.Let’s take another manifestation – cerebrovascular accident or stroke. It is clear that this is a formidable disease and it is necessary to know its features. In this case, dizziness is accompanied by severe headache, high blood pressure, in some cases with visual impairment. Additional signs may be numbness or muscle weakness in one half of the body – arm, leg, tongue, face. Even minor changes in appearance require an urgent call to the doctor. Vascular problems cause dizziness of a vascular nature.

– What role does osteochondrosis play in the appearance of dizziness?

– Osteochondrosis of the cervical spine only contributes to the appearance of dizziness in the presence of other disorders in the vascular system: with atherosclerosis or the specific structure of the vertebral arteries – when, for example, they are too narrow or more convoluted on one side. In osteochondrosis, as a result of the displacement of the vertebrae, a temporary subcompression of the arteries occurs, followed by overexcitation of vascular receptors and dizziness occurs.Most of the complaints are just mixed types of dizziness, in which both the vessels and the pathology of the cervical vertebrae are “to blame”.

– Can osteochondrosis provoke a stroke?

– With severe atherosclerosis, severe forms of diabetes mellitus, alcohol abuse, smoking and fatty foods, blood vessels are at increased risk. Their walls become thickened and rigid, which interferes with normal contraction and causes spasm.The displacement of the vertebrae in osteochondrosis even more strongly affects the arteries, aggravating this condition and leading to a nutritional deficiency in the brain. With a sharp outflow of blood from the brain, the pressure drops and the person can lose consciousness. When the nutrition of a certain part of the brain is disrupted, its work is disrupted and the activity of metabolic processes is significantly reduced. This can manifest as sudden speech impairment, facial asymmetry, or numbness in any part of the face, arm, or leg. If these symptoms disappear within an hour, this condition is called an ischemic attack – a temporary violation of cerebral circulation.An urgent need to see a doctor and be examined.

– So, you can’t put up with osteochondrosis just because “everyone” has it?

– Osteochondrosis cannot be completely cured, because metabolic processes slow down with age and a natural deformation of the vertebrae occurs. You can stop this process and improve your well-being by eliminating the negative effect of the vertebrae on the vessels. With the help of medicines, manual techniques, gymnastics and massage.But first, you need to establish the true cause of dizziness.

90,000 Dizziness: causes, types, treatment

Dizziness is one of the most common problems not only among older people, but also among young people. Many patients live with this syndrome for many months and do not seek qualified medical help, although modern treatment methods make it possible to forget about the discomfort after the first procedure *. In this article, a neurologist at the Pirogov clinic, Ramish Kurbanovich Shogenov, will talk about the types of dizziness, diseases that are associated with them, and at the end of the article he will debunk one of the popular myths.

On the variety of vertigo

So, by the word “dizziness” we can mean different symptoms: instability, staggering when walking, general weakness, darkening of the eyes, lightheadedness, etc. Diagnosing dizziness is difficult enough, because it is often difficult for a patient to describe his feelings. But in making a diagnosis, it is very important to correctly determine the type of dizziness.

There are basically two types of vertigo: systemic and non-systemic.

Systemic vertigo is similar to that which occurs after riding a carousel. That is, the patient feels that the earth is running away from under his feet, his gaze is not focused on objects, and they float to one side or the other. There is often such dizziness with nausea, high blood pressure and even vomiting.

Non-systemic dizziness includes all the other symptoms mentioned above (instability when walking, weakness, darkening in the eyes, light-headedness).

About diseases

There are a limited number of diseases that are related to systemic vertigo. Let’s talk about them in order of occurrence:

1) BPPV – benign positional paroxysmal vertigo (this is up to 50-60% of systemic vertigo). It occurs when the head is turned, most often in a horizontal position, when a person rolls over from one side to the other.This disease proceeds in an attack-like manner: a change in the position of the head or trunk provokes dizziness, which usually lasts up to 30 seconds. Then it fades and does not bother, if you do not move, but the next turn the attack will be repeated. Typically, BPPV patients find it much easier if they are upright.

2) Meniere’s disease is up to 15-20% of all systemic vertigo. In this case, it is not related to the position of the body and is accompanied by a noise in the ear or in the head on one side.With this disease, the head is very dizzy, this may be accompanied by nausea or vomiting. The peculiarity of this diagnosis is the obligatory appearance of noise in one ear (then noise from both sides can join) with the onset of dizziness and a decrease in noise with the cessation of dizziness. The duration of the attack is usually 3-5 days.

3) Vestibular migraine – 5-8% of all systemic vertigo. This is a relatively rare diagnosis, which is manifested by an attack of systemic dizziness (may be nausea) lasting 5-30 minutes, followed by the development of a headache.This is almost a mandatory symptom for making such a diagnosis.

4) Vestibular neuronitis – 5-8% of all systemic vertigo. This diagnosis is very similar to Meniere’s disease, but with the exception of one symptom – the absence of noise in the ears or in the head. Vestibular neuronitis is characterized by severe dizziness with nausea, vomiting, which do not depend on the position of the body. The patient may feel unsteadiness when walking for two months. The duration of the attack reaches 5-7 days, while the disease cannot worsen more than 2 times.If this happens, then the patient actually has a different diagnosis.

5) Rare types of dizziness: perilymphatic fistula, labyrinthitis, vestibular paroxysm, focal lesions of the brain, etc. – no more than 5%

About the causes of non-systemic dizziness

The most common cause (up to 80% of cases) of non-systemic dizziness is depression and stress. A feature of this type is the combination of dizziness with increased anxiety or apathy, with sleep disturbances, with emotional dysfunctions, etc.But to make this diagnosis, it is necessary to exclude other conditions that can lead to non-systemic dizziness. We will list them in the following paragraphs:

• Low blood pressure due to VSD (vegetative dystonia). Non-systemic dizziness occurs when there is a change in body position from horizontal to vertical or from sitting to standing.
• Decrease in the level of hemoglobin in the blood
• Decrease or increase in sugar level
• Large atherosclerotic plaques in the vessels of the neck
• Heart disease leading to a decrease in blood pressure
• Focal brain damage (vascular foci, multiple sclerosis, etc.))
• Other Rare Conditions

Many will now ask: “Where is cervical osteochondrosis? Have you forgotten that cervical osteochondrosis also leads to dizziness? ” No, we haven’t forgotten. Recent scientific studies have confirmed that there is practically no “cervical” dizziness, only as an exception to the rule. Certain conditions are necessary for the occurrence of cervical dizziness: the absence of one of the vertebral arteries, the openness of the Willis circle, an atherosclerotic plaque in the only vertebral artery.The combination of these factors is extremely rare, and it is likely to lead to ischemic stroke, rather than isolated dizziness. Therefore, as you can see, the word “osteochondrosis” is not present anywhere. This is all a myth.

The most common type of vertigo – BPPV is treated in just 1-3 doses. So, if you are worried about dizziness provoked by turning your head in a horizontal position, contact our clinic and we will help you.

* The number of procedures required depends on the medical case of a particular patient

Dizziness: we understand the reasons – IPM Clinic

Dizziness (vertigo) is a feeling of disorientation of the body in space.It seems to a person that he or the objects that surround him rotate. Everyone experiences different impressions, ranging from drunkenness to faintness and instability.

The causes of this disorder can be very varied. Some of them are combined, so it is not always easy to determine at once why the head is spinning. Most often, the reasons are quite harmless – fatigue, hunger, motion sickness. But in some cases, it can be a sign of a serious illness.

Classification of vertigo:

1.Central dizziness – caused by disorders and diseases of the brain. These can be injuries, tumors, hemorrhages.

2. Peripheral dizziness – occurs as a result of exposure to or damage to the inner ear or VIII pair of cranial nerves.

Systemic and non-systemic (physiological) dizziness is also distinguished:

1. Systemic dizziness occurs when one of the systems that are responsible for orientation in space fails: visual, vestibular or muscular.This type requires careful diagnosis and complex treatment.

2. Non-systemic (physiological) can be caused by neurogenic causes – stress, overwork. Lack of glucose – low-carb diets, fasting. Sometimes the reason lies on the surface: a child has been riding a carousel for a long time, or a person experiences rolling during a sea voyage. In this case, the reason is the discrepancy between visual images and physical sensations. Such an attack passes on its own and there is no need to diagnose the body.

Additional symptoms and various laboratory research methods, including special vestibular diagnostics, can help to understand what exactly caused vertigo.

Causes of dizziness:

In order to correctly determine the cause of dizziness and prescribe adequate treatment, you need to know what features it has in various diseases and what signs are accompanied by.

• Inflammation of the inner ear.In this condition, dizziness is accompanied by discharge from the ear and hearing loss. Also, the cause can be a sulfuric plug in the external ear canal.
• Meniere’s disease. In addition to frequent and severe dizziness, tinnitus, hearing loss, nausea and vomiting are noted.
• Vestibular neuritis. In this case, increased dizziness is characteristic when standing up and turning the head. The disease begins abruptly, after 2-3 days the patient feels better. But for some time the illusion of movement remains after acceleration (lifting in an elevator, braking a car).
• Acute cerebrovascular accident (stroke). During cerebral hemorrhage, vertigo begins acutely. It is persistent and long lasting. It can be accompanied by double vision, severe weakness, impaired speech, muscle sensitivity and coordination in space.
• Osteochondrosis of the cervical spine. Dizziness with cervical osteochondrosis increases with movement, especially with sharp turns and lifting of the head. Also, patients have an unstable gait and disorientation in space, pain and limited movement in the cervical spine.
• Tumors and other neoplasms of the brain. The attack grows very gradually and intensifies in certain positions of the body, often accompanied by headaches and one-sided deafness.
• Perilymphatic fistula. It is characterized by dizziness, tinnitus, and sudden one-sided deafness. Also, patients suffer from nausea and vomiting.
• Injury to the head or spine. Also accompanied by nausea and weakness.
• Benign paroxysmal positional vertigo.It is characterized by an increase in the attack when the position of the body in space changes. There is a special test to confirm this disease and special treatment methods carried out by a vestibulologist.
• Basilar migraine. Vertigo begins an hour before the attack and is accompanied by various neurological symptoms, as well as tinnitus, darkening of the eyes, nausea and vomiting.
• Pathology of the eye muscles. The reason is the fast change of pictures. It goes away on its own in a few minutes.
• Taking antibiotics and other medications. Sometimes vertigo is a side effect of medications: anticonvulsants, sedatives, lowering blood pressure, heart. As a rule, this is indicated in the instructions. In this case, it is necessary to reduce the dose, or to correct therapy (replacement) or stop taking the drug after consulting a doctor.

There are also reasons for vertigo based on two separate criteria: gender and age.

1.Aged people. The causes of dizziness according to this criterion are associated with degenerative changes in the vessels, vestibular system, cranial nerves, brainstem apparatus, cerebellum, subcortical nuclei of the brain. They can also cause visual impairment.

Often, older people experience persistent seizures due to changes in the psyche. And almost always they are accompanied by depression and phobias (psychogenic dizziness).

2. Women. For women, another reason is characteristic – this is hormonal changes in the body.An increase in the level of hormones in the blood can cause dizziness with menstruation, as well as with menopause. During critical days, this malaise is also associated with anemia. A woman’s body loses hemoglobin faster than it can produce it. This can cause oxygen starvation of the brain, which affects the appearance of such phenomena as dizziness, depression, mood swings. Pregnancy can also cause dizziness and nausea.

During menopause, women often experience surges in blood pressure, and the excitability of the autonomic nervous system increases.This is often accompanied by mild to severe dizziness.

Diagnostics:

Depending on the type and alleged causes of a particular dizziness, the doctor establishes a number of specific diagnostic studies:

– MRI or MSCT (according to indications) of the brain (if necessary, additionally – with a contrast agent).

– Electroencephalography (EEG).

– DS with CDC BCA.

– Audiometry.

– Special diagnostic tests carried out by a doctor.

Treatment of dizziness:

After establishing the cause and diagnostics, a complex treatment is prescribed.

If an acute violation of cerebral circulation (stroke) is detected, emergency hospitalization is required, and neuroprotective treatment should be carried out in a hospital setting.

In case of decompensation of chronic cerebrovascular accident, according to indications, patients can undergo a course of treatment in a day hospital as planned, or with mild symptoms at an outpatient stage.

For a number of diseases associated with the inner ear, patients often need to be managed in parallel by two specialists – a neurologist and an otorhinolaryngologist. Specially trained specialists (otoneurologists, vestibulologists) conduct a number of sessions of vestibular rehabilitation, drug therapy is selected on an individual basis.

When tumors, neoplasms (in particular, neuroma of the VIII pair of cranial nerves) are detected, a neurosurgeon’s consultation is always required to decide on the further tactics of managing such a patient (perhaps surgery may be required).

The doctor often advises taking sedatives (andaxin, seduxen), antihistamines (diphenhydramine, pipolfen) and anti-nausea drugs (cerucal).

For proponents of non-drug methods of treatment, it is advisable to take infusions of ginkgo biloba. Ginger tea is also very effective in this case. Mint or lemon balm tea can help calm an attack. It should be drunk after lunch and dinner.

In certain cases, it is necessary to saturate the body with iodine, phosphorus, which can reduce problems with the vestibular apparatus.Also the use of certain products: carrot and beet juices. They must be drunk on an empty stomach. Pomegranate juice is also effective, which helps to raise hemoglobin.

Dizziness in itself is not life-threatening, but it can indicate serious health problems or be a prerequisite for an acute illness with serious consequences. In this case, it is imperative to consult a doctor and / or, if necessary, call an ambulance.

Worried about dizziness? Make an appointment with a neurologist!

Phone for appointment: (391) 255-97-79

November 22, 2017

Dizziness – Family clinic “Medis”

The author of the article: Neurologist at the Medis Family Clinic, Candidate of Medical Sciences Irina Fedorova

We are used to treating dizziness lightly. “I’m dizzy, now I’ll sit and it will pass,” we say frivolously, feeling unwell.Indeed, light dizziness in most cases is not dangerous. You can only stumble when you feel vertigo – this is what doctors call this phenomenon.

But it often happens that dizziness is a symptom of very unpleasant and even life-threatening diseases – tumors, stroke, meningitis … Doctors advise in certain cases to go to clinics faster or even call an ambulance. When is it worth worrying?

– if dizziness is repeated daily or lasts more than an hour;

– if dizziness occurs paroxysmal.You try to get out of bed in the morning, but you cannot even get up because of sudden dizziness;

– if dizziness is unconventional, for example, objects do not move in a circle, but in a different plane;

– if dizziness is accompanied by a sharp increase or decrease in pressure.

About 80 reasons that can cause dizziness have been identified, of which about 20% are complex. But most often these reasons are associated with neurology, therefore, with a complaint of dizziness, it is best to first consult a neurologist.

What is dizziness from a medical point of view?

In a healthy person, a state of equilibrium occurs due to a combination of signals coming into the cerebral cortex from the vestibular, visual and proprioceptive systems. Impulses from the cerebral cortex reach the skeletal and eye muscles and provide a stable posture and the desired position of the eyeballs. In the event that the flow of impulses from the vestibular sections into the cortex of the temporal and parietal lobes is impaired, the perception of surrounding things or the whole body becomes illusory.It seems to a person that he himself or the objects around him move in space in a circle. Constant companions of dizziness are nausea and vomiting, tinnitus. The gait becomes wobbly and unstable, and weakness begins. It seems to a person that his heart began to beat faster, he is sweating. After an attack of vertigo, he falls asleep. An increase in body temperature is possible.

Dizziness can be a symptom of what neurological diseases?

Various diseases of the brain can cause dizziness, then it is called central.I will name some of the common diseases characterized by dizziness.

• Viral meningitis is a serious disease that is an inflammatory process in the membranes surrounding the spinal canal and brain. The signs of illness are similar to those of the flu, and include a stiff neck and severe headache.

• Stroke. Dizziness on the eve of a stroke is common in older people. This is due to damage to the back of the brain that causes poor circulation.You can reduce your risk of stroke by controlling your weight, avoiding cigarettes, being active, and reducing your alcohol intake.

• Circulatory disorders of the brain. During sedentary work, a large load is placed on the spine and cervical spine, as a result of which, if you do not get up for a long time, the blood circulation of the brain is impaired. Therefore, when a person stands up, there is a slight dizziness.

• Vestibular migraine. About 40% of people suffering from migraines also feel dizzy.Then nausea and loss of balance are added to the strongest headache.

• Cervical osteochondrosis. Dizziness with osteochondrosis increases with head movement, especially with sharp turns and rises. Patients sometimes have unstable gait and disorientation in space. All this is accompanied by pain and limited movement in the cervical spine.

• Perilymphatic fistula. It is characterized by dizziness, tinnitus, sudden one-sided deafness.Also, patients suffer from nausea and vomiting.

Vertigo can also occur from damage to the inner ear or vestibular nerve. This vertigo is called peripheral and is dealt with by ENT doctors. Otorhinolaryngologist-audiologist Zlata Polishchuk explains what might be wrong if you feel dizzy:

The organ of hearing is located in the temporal part of the skull. In the same zone, the vestibular apparatus is located, which is responsible for the sense of space and balance of the body.Therefore, diseases of the ENT organs are often accompanied by dizziness. It could be:

• Calcium deposits in the inner ear. The problem is more related to older women. In this case, benign positional vertigo appears. It can last for many months, often occurs with head movements, and may be accompanied by involuntary eye movements.

• Meniere’s disease is a disorder of the inner ear that causes dizziness, ringing in the ears and hearing problems.It is a chronic condition that has no cure, but it is possible to reduce the severity of symptoms. Dizziness attacks plague people with this condition because the tissues of the inner ear are under powerful pressure from fluids, which causes the abnormal condition.

• Acute labyrinthitis. Inner ear otitis media can cause very severe dizziness. When the nerves in the inner ear are affected by inflammation, the brain is unable to normally recognize information about head position and balance.A variety of infections, from measles to hepatitis, can cause this condition.

Since there can be many reasons for dizziness, the patient needs to undergo a comprehensive examination.

First, the neurologist will suggest that the patient undergo several tests, which will be aimed at assessing the functioning of the vestibular apparatus. This can be a caloric test or rotational tests, a posturographic method. Then, depending on the symptoms, the following can be prescribed:

– MRI of the brain.MRI of the neck,

– Doppler ultrasound of the vessels of the brain and blood vessels and duplex scanning of the brachiocephalic vessels,

– fundus examination by an ophthalmologist,

– X-ray of the cervical spine, with functional tests,

– registration of visual evoked potentials,

– audiometry and acoustic impedance measurement.

To assess the state of the vascular system, the patient may be referred for CT or ultrasound.It is also possible to perform an EEG.

You should not be afraid of dizziness, panic with this symptom is unnecessary. However, there is no need to hesitate to see a doctor if dizziness begins to bother you. Experienced specialists are waiting for you at the Medis clinic, who will not fight the symptoms, but will find out the cause of the dizziness and cure them.

90,000 Dizziness: what is behind one of the main ailments of the elderly

It should be noted that dizziness is not a disease, but only a symptom.The main question is – a symptom of what? After all, there can be at least eighty reasons for dizziness.

Dizziness is one of the most frequent complaints with which patients rush to the doctor. It is the second most common reason for visiting a doctor after pain.

As the Associate Professor of the Department of Neurology and Neurosurgery of the First Moscow State Medical University named after M.V. Sechenova, neurologist Natalya Vakhnina, each person can mean completely different things by dizziness. Someone complains about imbalance, others – about the feeling of rotation around their own axis or objects around themselves.Some people feel as if they have something spinning inside their heads. And there are those who stagger while walking or feel as if they have been hit on the head with a dusty bag or the earth is slipping out from under their feet. Among the popular complaints, one can single out lightheadedness, nausea, general weakness, a feeling of impending fainting, fog in the head … “In Russian, the word“ dizziness ”is a very ambiguous term, and people call it a variety of symptoms. Therefore, it is very difficult to diagnose real dizziness, ”notes a leading researcher at the Clinic of Nervous Diseases of the First Moscow State Medical University.Sechenov Maxim Zamergrad.

In principle, each of us at least once in his life could say “Oh, how dizzy!” In the elderly, this condition occurs much more often – with age, all feelings become dulled, and dizziness becomes a habitual phenomenon. Moreover, to a greater extent, this problem affects the representatives of the beautiful half of humanity, who suffer from vertigo 2-4 times more often than men.

As Natalya Vakhnina explains, when they lose their balance, even many young people feel a state of horror and despair, let alone the elderly.Many organs and systems work on the sense of balance in the body – from muscles and joints to sensory receptors and the inner ear system. And yet, the main cause of dizziness is disruption of the vestibular apparatus. It is this type of vertigo that is called “vertigo” (from the Greek vertere – to rotate).

To put it quite simply, the vestibular apparatus reacts to all our movements and transmits signals directly to the brain. Additional symptoms of vertigo are often nausea and even vomiting, lightheadedness, and cold sweats.Hearing impairment and / or tinnitus may also occur. With such complaints, it is best to contact an ENT or a neurologist (there is also a narrower specialist – an otoneurologist). In practice, to find out the real cause of dizziness, the patient bypasses on average four specialists, and up to 75% of dizziness remain unrecognized and untreated.

Experts also distinguish a group of non-systemic vertigo. With them, a person feels like a little drunk. Typical symptoms are a condition close to fainting; increased anxiety; heart palpitations, staggering and swaying.These symptoms can be so severe that patients are forced to lie in the dark until the attack subsides because they are unable to do anything.

Among other causes of dizziness, it is worth highlighting intoxication (alcoholic hypotensive and antidepressants), joint diseases, cardiovascular diseases, stroke, swelling, trauma, multiple sensory insufficiency. By the way, sometimes dizziness is the only symptom of a stroke, so you need to see a doctor anyway.“Often the cause of dizziness in the elderly is a change in the joints (for example, the hip). A competent doctor will certainly consider all these possible problems, ”says Natalya Vakhnina.

But the most severe dizziness occurs with Meniere’s disease – a severe but relatively little-known chronic disease that affects one in 25 thousand people annually in the world. Vincent Van Gogh suffered from Meniere’s disease, as is now known. The pains tortured him so much that he decided to cut off his ear.

– This may sound strange, but we recommend that older people with dizziness move more often, such as walking. Many of them are afraid to leave the house because they think they will fall. At the same time, they walk around the apartment confidently. Of course, in such cases, cognitive therapy is indicated, which will help to cope with this phobia, continues Natalya Vakhnina.

It is clear that, before prescribing treatment, the doctor must find out the exact cause of vertigo in the elderly.There is a group of drugs that relieve the unpleasant symptoms of this condition (vestibulolytics), but they cannot be drunk systematically due to the fact that they cause a rather wide range of side effects. There are also drugs from the class of nootropics (including in the form of lozenges, which is especially convenient for the elderly, since some of them have difficulty swallowing), which allow you to adapt the balance system and improve the function of the brain centers. Such medicines, on the contrary, need to be taken in a course and they are used only as prescribed by a doctor and are dispensed with a prescription.

In addition, patients with dizziness are often prescribed special remedial gymnastics based on eye movement training. For example, the doctor asks the patient to follow the movements of the ball with his eyes (the ball in the outstretched hand can be moved by himself). Try sticking a piece of plaster on the mirror and turning your head to watch it. Similar exercises are also available in a virtual version – they can be performed during a method called biofeedback (BFB).All of these exercises help to train balance.

And, of course, physical activity is very important. A half-hour walk a day is quite enough for an elderly person. Even with a stick. This will reduce the risk of repeated dizziness at times.

In addition, it would be good for patients to reconsider their diet. If possible, exclude chocolate, spicy and fatty foods, salty foods from the diet.