• A symptom, not a disease process. Causes can be peripheral or central.
  • Often described as a sensation of movement (“room spinning”) when no movement is actually occurring
  • One of four types of dizziness (vertigo, presyncope, lightheadedness, disequilibrium) (1)
  • System(s) affected: nervous, cardiovascular, psychiatry
  • Synonym(s): dizziness



  • Vertigo/dizziness accounts for >4 million ED visits a year in United States, of which 80–85% have no serious underlying condition (2).
  • Women are 3 times more likely to experience vertiginous migraine (1).

Geriatric Considerations

  • Keep a higher index of suspicion for cardiovascular disease (CVD), 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).

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); BPPV, vestibular neuritis, and Ménière disease account for majority of peripheral causes (1).
  • Central causes: cerebellar tumor, stroke, migraine, vestibular ischemia (1),(2)
  • Numerous drug 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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