Vertigo
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Basics
Description
- A symptom, not a disease process. Causes can be peripheral or central, benign, or life-threatening. Cause determines treatment.
- May be described as a sensation of movement (“room spinning”) when no movement is actually occurring
- However, do not rely on symptom quality—often unreliable. Focus on timing and triggers.
- System(s) affected: nervous, cardiovascular, psych
- Synonym(s): dizziness
Epidemiology
Incidence- Vertigo/dizziness accounts for >4 million ED visits a year in United States, of which 80–85% have no serious underlying condition (1).
- Predominant sex: female = male; women are 3 times more likely to experience vertiginous migraine (2).
Geriatric Considerations
- Keep a higher index of suspicion for CVD, arrhythmias, and orthostatic hypotension.
- Benign Paroxysmal Positional (BPPV) is more common in ages 50 to 70 years (2), an important risk factor for falls but is often undiagnosed.
- Medications are implicated almost 1/4 of the time (2).
- Ranges from 5% to 10% within the general population
- Lifetime prevalence for BPPV is 2.4%.
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
- Peripheral causes: acute vestibular neuritis, BPPV (posterior canal 85–95%, lateral canal 5–15%), Ménière disease, otosclerosis, acute labyrinthitis, cholesteatoma, perilymphatic fistula, superior canal dehiscence syndrome, motion sickness (2). BPPV, vestibular neuritis, and Ménière disease account for majority of peripheral causes (2).
- Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (1,2)
- Drug causes: psychotropic agents, anticonvulsants, aspirin, aminoglycosides, furosemide (diuretics), amiodarone, α-/β-blockers, nitrates, urologic medications, muscle relaxants, phosphodiesterase inhibitors (sildenafil), excessive insulin, ethanol, quinine, cocaine
- Other causes: orthostasis, arrhythmia, psychological
Genetics
Family history of CVD/migraines may indicate higher risk of central causes.
Risk Factors
- History of migraines
- History of CVD/risk factors for CVD
- Use of ototoxic medications
- Trauma/barotrauma
- Perilymphatic fistula
- Heavy weight-bearing
- Psychosocial stress/depression
- Exposure to toxins
General Prevention
If due to motion sickness, consider pretreatment with anticholinergics, such as scopolamine.
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A symptom, not a disease process. Causes can be peripheral or central, benign, or life-threatening. Cause determines treatment.
- May be described as a sensation of movement (“room spinning”) when no movement is actually occurring
- However, do not rely on symptom quality—often unreliable. Focus on timing and triggers.
- System(s) affected: nervous, cardiovascular, psych
- Synonym(s): dizziness
Epidemiology
Incidence- Vertigo/dizziness accounts for >4 million ED visits a year in United States, of which 80–85% have no serious underlying condition (1).
- Predominant sex: female = male; women are 3 times more likely to experience vertiginous migraine (2).
Geriatric Considerations
- Keep a higher index of suspicion for CVD, arrhythmias, and orthostatic hypotension.
- Benign Paroxysmal Positional (BPPV) is more common in ages 50 to 70 years (2), an important risk factor for falls but is often undiagnosed.
- Medications are implicated almost 1/4 of the time (2).
- Ranges from 5% to 10% within the general population
- Lifetime prevalence for BPPV is 2.4%.
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
- Peripheral causes: acute vestibular neuritis, BPPV (posterior canal 85–95%, lateral canal 5–15%), Ménière disease, otosclerosis, acute labyrinthitis, cholesteatoma, perilymphatic fistula, superior canal dehiscence syndrome, motion sickness (2). BPPV, vestibular neuritis, and Ménière disease account for majority of peripheral causes (2).
- Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (1,2)
- Drug causes: psychotropic agents, anticonvulsants, aspirin, aminoglycosides, furosemide (diuretics), amiodarone, α-/β-blockers, nitrates, urologic medications, muscle relaxants, phosphodiesterase inhibitors (sildenafil), excessive insulin, ethanol, quinine, cocaine
- Other causes: orthostasis, arrhythmia, psychological
Genetics
Family history of CVD/migraines may indicate higher risk of central causes.
Risk Factors
- History of migraines
- History of CVD/risk factors for CVD
- Use of ototoxic medications
- Trauma/barotrauma
- Perilymphatic fistula
- 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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