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- 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 (1).
- System(s) affected: nervous, cardiovascular, psych
- Synonym(s): dizziness
- Vertigo accounts for half of cases of dizziness reported in primary care; >90% of these patients are diagnosed with peripheral causes (2).
- Predominant sex: female = male; women are 3x more likely to experience vertiginous migraine (1).
- Keep a higher index of suspicion for CVD, arrhythmias, orthostatic hypotension.
- BPPV is most common among the elderly, is often undiagnosed, and is an important risk factor for falls.
- 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 (1,2). BPPV, vestibular neuritis, and Ménière disease account for 93% of all 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
Family history of CVD/migraines may indicate higher risk of central causes.
- History of migraines
- History of CVD/risk factors for CVD
- Use of ototoxic medications
- Perilymphatic fistula
- Heavy weight bearing
- Psychosocial stress/depression
- Exposure to toxins
If due to motion sickness, consider pretreatment with anticholinergics, such as scopolamine.