Vertigo

BASICS

DESCRIPTION

  • Vertigo is a sensation of perceived motion (“room spinning”) with no motion is happening. Differs from dizziness which is a disturbance of orientation without movement.
  • One of the four types of dizziness (vertigo, presyncope, light-headedness, disequilibrium)
  • A symptom, not a disease process; causes can be peripheral or central
  • System(s) affected: nervous, cardiovascular, psychiatry
  • Synonym(s): dizziness.

EPIDEMIOLOGY

Incidence

Vertigo/dizziness accounts for >4 million ED visits a year in United States—only 15% have a serious underlying condition (1),(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),(3).

ETIOLOGY AND PATHOPHYSIOLOGY

  • 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 (3).
  • 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 (3).
  • Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (3)
  • Numerous drug causes (1),(3)

Genetics

Unknown

RISK FACTORS

  • History of migraines
  • History of CVD/risk factors for CVD
  • Use of ototoxic medications
  • Trauma/barotrauma/heavy weight-bearing
  • Psychosocial stress/depression
  • Exposure to toxins

GENERAL PREVENTION

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

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