Vertigo

Basics

Vertigo is a sensation of perceived motion with no motion is happening; differs from dizziness, which is a disturbance of orientation without movement (1)
A symptom, not a disease process; causes can be peripheral or central (1)
Often described as a sensation of movement (room spinning) when no movement is actually occurring (1)
One of the four types of dizziness (vertigo, presyncope, lightheadedness, disequilibrium) (1),(2)
System(s) affected: nervous, cardiovascular, psychiatry
Synonym(s): dizziness

Incidence

Vertigo/dizziness accounts for >4 million ED visits a year in the United States, of which only 15% has a serious underlying condition (2),(3).
Women are three times more likely to experience vertiginous migraine (2).

Geriatric Considerations

Higher index of suspicion for cardiovascular disease, arrhythmias, and orthostatic hypotension
Benign paroxysmal positional vertigo (BPPV) is more common in ages 50 to 70 years.
Medications are implicated 1/4 of the time (1),(2).

Dysfunction of the rotational velocity sensors of the inner ear results in asymmetric central processing; combination of sensory disturbance of motion and malfunction of the central vestibular apparatus (1)
Peripheral causes: acute vestibular neuritis, BPPV caused by otoliths in the posterior canal 85–95% and lateral canal 5–15%, Ménière disease, otosclerosis, acute labyrinthitis, cholesteatoma, perilymphatic fistula, superior canal dehiscence syndrome, motion sickness; BPPV, vestibular neuritis, and Ménière disease account for the majority of peripheral causes (1).
Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (1)
Numerous drug causes (1),(2)

Genetics
Unknown

If due to motion sickness, consider pretreatment with anticholinergics, such as scopolamine.

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