Description

• 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

Epidemiology

Incidence

• 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).

Prevalence
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

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.