Vertigo overview

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Vertigo Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Vertigo from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Vertigo is identified as 'room spinning around'. It is a type of dizziness. Presyncope, lightheadedness and disequilibrium are other types of dizziness and should be ruled out. The cause of vertigo can be peripheral or central in origin. In peripheral vertigo, dysfunction is in the vestibular system which includes the vestibule (utricle and saccule), semicircular canals, and the vestibular nerve. Central etiologies of vertigo usually originates from the brainstem or cerebellum. Most common causes of vertigo in primary-care setting are benign paroxysmal positional vertigo, acute vestibular neuronitis, or Ménière’s disease.

Historical Perspective

  • Vertigo is derived from the Latin words vertigin and vertere which means "a whirling or spinning movement," and "to turn", respectively.

Classification

  • Vertigo is classified on the basis of the location of dysfunction into:
  • It can also be classified on the basis of its time course or duration:
    • Lasting a day or longer
    • Lasting minutes to hours
    • Lasting seconds

Pathophysiology

Causes

Differentiating Vertigo from other Diseases

Epidemiology and Demographics

Risk Factors

  • There are no established risk factors for vertigo, as it is a symptom of an underlying disease.
  • However, vertigo can be prevented in some cases by controlling risk factors for the underlying cause.

Screening

  • There is insufficient evidence to recommend routine screening for vertigo.

Diagnosis

Diagnostic Study of Choice

  • There are no established criteria for the diagnosis of vertigo.
  • To diagnose vertigo etiology a complete history with the focal examination is necessary.

History and Symptoms

  • It is important to differentiate between other causes of dizziness before evaluating for the cause of vertigo.
  • True vertigo is described as the room spinning around the patient.
  • Once true vertigo is established next step is to identify if the origin of dysfunction is central or peripheral.
  • Detailed investigation of time course of vertigo and associated signs and symptoms aid in identifying the cause of vertigo.

Physical Examination

  • Physical examination of patients experiencing vertigo should include assessment of cranial nerves, nystagmus, sensorineural hearing loss (Rinne or Webers test), otoscopic exam of the ear canal and tympanic membrane, HINTS (cover/uncover test), Dix-Hallpike maneuver, and/or Hennebert’s sign.

Laboratory Findings

  • There are no diagnostic laboratory findings associated with vertigo.

Electrocardiogram

  • There are no ECG findings associated with vertigo.
  • ECG monitoring may be indicated if the cause of dizziness is uncertain.

X-ray

  • There are no x-ray findings associated with vertigo.

Echocardiography or Ultrasound

CT scan

  • CT scan is not the first-line imaging preferred to determine the underlying cause of central vertigo.
  • If MRI is contraindicated then a thin cut CT scan can be used.

MRI

  • An MRI is the first-line imaging if the cause of vertigo is suspected to be central in origin.
  • MRI is superior to a CT scan due to its ability to visualize the posterior fossa.

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

  • For the majority of underlying causes of vertigo, the mainstay of treatment is medical therapy. Surgery is usually reserved for patients with either tumor-associated vertigo, cholesteatoma, and/or when it does not respond to multiple medical therapies.

Primary Prevention

  • There are no established measures for the primary prevention of vertigo, as it occurs as a symptom of underlying pathology.
  • In some diseases controlling risk factors or triggering factors can prevent the disease hence preventing the symptoms.

Secondary Prevention

References