Description

• 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

Epidemiology

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).

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 (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

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.