The most common cause of vertigo is the condition known as benign paroxysmal positional vertigo (BPPV); BPPV is a disorder of the vestibular apparatus.
Often, vertigo sufferers also complain of other symptoms, including: nausea, vomiting, loss of balance, nystagmus, sweating and / or hearing loss.
In order to properly treat vertigo, it is essential, during the diagnosis, to identify the precise triggering causes.
or brain stem - are better known as central vertigo.
Causes of Peripheral Vertigo
The most common causes of peripheral dizziness are:
- The condition known as benign paroxysmal positional vertigo BPPV.
Benign paroxysmal positional vertigo is by far the most common cause of vertigo.
According to reliable scientific studies, the onset of vertigo in those suffering from BPPV is due to the formation of calcium carbonate crystals, inside the semicircular canals constituting the vestibular apparatus.
With their movement, these calcium carbonate crystals would compromise the proper functioning of the balance organ and cause the typical sensation of the surrounding environment that turns.
More common in the elderly population, BPPV tends to arise without particular reasons; however, in rare circumstances, it appears after: ear infections, ear surgery, head trauma or long periods in bed (for example due to a serious illness). - The labyrinthitis.
Labyrinthitis is the inflammation of the labyrinth, that is the set of all the semicircular canals that make up the vestibular apparatus of the inner ear.
Typically, labyrinthitis occurs as a result of a "viral infection (a cold or a" flu) or bacterial (an "ear infection); more rarely, it can result from a head injury or allergic reaction.
Labyrinthitis causes dizziness because, in the presence of an "inflammation in it, the labyrinth works inadequately and sends wrong signals to the brain. - Vestibular neuronitis.
Vestibular neuronitis is the inflammation of the nerves that connect the labyrinth to the brain and allow the precise regulation of balance.
With their inflammation, the aforementioned nerves function incorrectly, inadequately transmitting the nerve signals along the "vestibular system - brain" path.
Vestibular neuronitis usually has a viral origin. - Ménière's syndrome.
Ménière's syndrome is a disease of the inner ear which, according to the most accredited hypotheses, would arise due to an accumulation of endolymph inside the labyrinth. Endolymph is the liquid present inside the semicircular canals of the vestibular apparatus, which plays a fundamental role in the transmission of nerve signals for the regulation of balance. - Some Medicines.
The list of drugs that, as a side effect, can cause peripheral dizziness includes: aminoglycosides, cisplatin, antibiotics, diuretics, cisplatin, salicylates, etc.
Causes of Central Vertigo
The most common causes of central vertigo include:
- Migraine.
It is a pathological condition characterized by unilateral headaches (i.e. on one side of the head only), which tend to worsen and are capable of causing intense and throbbing pain. - Multiple sclerosis.
It is a chronic and disabling disease, which arises as a result of a progressive degradation of the nerve cells (neurons) of the central nervous system. - Acoustic neuroma (or vestibular Schwannoma).
It is a benign brain tumor, affecting the Schwann cells of the VIII cranial nerve (or vestibulocochlear nerve).
The VIII cranial nerve is a sensory nerve that controls hearing and balance. - Tumors of the brain, located in the cerebellum (tumors of the cerebellum).
The cerebellum is one of the four regions that make up the brain. Its job is to coordinate the movements of the body. - Stroke or TIA.
The term stroke and its many synonyms - including stroke, cerebral infarction, and stroke - indicate an "interruption or sharp reduction in blood supplies directed to one" area of the brain.
This lack of adequate blood supplies results in the progressive death of the affected brain region.
A TIA, or transient ischemic attack, is a stroke characterized by a "temporary interruption of blood supplies. - Medicines.
Medicines which, as a side effect, can cause dizziness are, for example, anticonvulsants.
In some individuals, the sensation induced by dizziness and the accompanying symptoms may be barely mentioned; in others, however, they may also be very marked and severe.
Vertigo - How Long Do They Last?
Dizziness and associated symptoms vary in duration from patient to patient: in some subjects, they may vanish after a few seconds / minutes; in others, however, they can last for several hours, or even days.
The type of triggering causes generally affects the duration of vertigo and accompanying manifestations.
Vertigo - How Do They Appear?
Depending on the triggering conditions, dizziness can appear suddenly or gradually.
Vertigo: When To See Your Doctor?
It is good to consult a doctor when dizziness is a recurring / persistent symptom or when it occurs in a very marked way.
Symptoms Benign Paroxysmal Positional Vertigo
Since benign paroxysmal positional vertigo is the most common cause of dizziness, it is worth remembering what other characteristic symptoms of this particular medical condition are:
- Nausea;
- Loss of balance
- Nystagmus and other visual disturbances. The presence of nystagmus in an individual is often an indication of a problem at the level of the organ of equilibrium;
- Vomiting (rarely)
- Syncope presyncope (rarely).
Survey
For patients who complain of dizziness, doctors usually ask:
- A description of the first episode of vertigo.
- A description of any associated symptoms. In these situations, it is particularly important for the physician to know if the patient has suffered from hearing loss, tinnitus, nausea and / or vomiting.
- How frequent are the episodes of dizziness and how long they last.
- If the episodes of vertigo impair the performance of normal daily activities, such as walking, working, etc.
- If there are particular gestures or movements that worsen the symptoms. For example, a particular movement of the head or getting up quickly from a chair or bed are two acts often associated with a worsening of symptoms.
- If there is something that improves symptoms, when they are on.
Physical examination
The physical examination represents the first step towards identifying the condition that triggers the episodes of vertigo.
In carrying out it, the doctor visits the patient, evaluating the symptoms.
Internal ear testing and testing for nystagmus are two key moments in the physical examination.
In-depth exams
By prescribing more in-depth tests, the diagnostician is often able to trace the causes of dizziness.
The knowledge of the triggering factors allows to plan the most appropriate therapy for the case in question.
The in-depth examinations include:
- Various hearing tests (or audiometric tests). They clarify whether the patient is suffering from tinnitus and / or hearing loss.
- Videonystagmography and electronystagmography. They are two exams for the detailed analysis of the signs of nystagmus. Both require the patient to wear special glasses and observe moving objects.
- Thermal tests for the ear. They involve the introduction of hot or cold solutions (or, alternatively, hot or cold air) into the patient's ear, in order to see how temperature changes affect the "organ of the" balance, located at the level of the inner ear.
They are painless tests, but they cause dizziness.
Typically, introducing hot or cold solutions (or air) into the ear takes about 30 seconds. - A posturographic exam. It involves the use of a particular machine that evaluates the patient's ability to balance, providing useful information about vision, proprioception, etc.
- Imaging tests. Generally, the most common are CT and nuclear magnetic resonance imaging (MRI). CT and MRI are painless procedures, which provide the doctor with detailed images of the internal organs and tissues of the human body.
Unlike MRI, CT is slightly invasive, as it exposes the patient to a non-negligible dose of ionizing radiation.
In all those circumstances in which the labyrinthitis has impaired the hearing abilities, it is advisable to contact an expert in ear diseases and hearing disorders, to receive the most appropriate treatment for the case.
Some forms of labyrinthitis require a treatment known as vestibular rehabilitation.
Brief discussion: what is vestibular rehabilitation?
Vestibular rehabilitation basically consists of an exercise program whose purpose is to induce an adaptation by the brain to the dizziness present.
In other words, it is a treatment aimed at accustoming the brain to the abnormal sensations present during an episode of dizziness.
Vestibular neuronitis: How is it treated?
Usually following a "viral infection, vestibular neuronitis is a condition that generally tends to heal spontaneously, without special treatment.
The healing process could take several weeks.
When dizziness is particularly severe and associated with bothersome symptoms (vomiting, nausea, etc.), doctors recommend lying in bed until it is over and, in some cases, taking certain medicines, such as prochlorperazine and antihistamines.
In the presence of vestibular neuronitis, it is highly not recommended to drink alcohol and get excessively tired.
Benign Paroxysmal Positional Vertigo: How is it Treated?
Typically, people with paroxysmal positional vertigo recover spontaneously within several weeks or months.
According to experts, the resolution of VPPB is linked to the dissolution of calcium carbonate crystals, circulating in the semicircular canals of the vestibular apparatus.
However, it should be noted that, to speed up the healing process and to improve the symptomatological picture, doctors recommend:
- Get out of bed slowly.
- Avoid looking upwards, therefore avoid activities that may induce you to do this.
- Undergo the Epley maneuver. The Epley maneuver consists in the execution of 4 specific movements of the head, the purpose of which is to move the calcium carbonate crystals and position them in points that are harmless (or in any case less influential) from a symptomatic point of view.
- If the Epley maneuver has poor results or is inoperable due to neck problems on the part of the patient, practice the Brandt-Daroff exercises.
If the Epley maneuver and the Brandt-Daroff exercises are ineffective, if the symptoms do not seem to improve and if still other disorders appear, it is advisable to contact the specialist again and rely on his indications.
Ménière syndrome: How is it treated?
There are various treatments for vertigo induced by Ménière's syndrome.
Possible treatments include:
- Adopting a low-sodium diet. To learn more, read: Diet for Ménière's Syndrome.
- The intake of prochlorperazine, cinnarizina and cyclizine, for the treatment of dizziness and some symptoms such as nausea and vomiting.
- The intake of betahistine, gentamicin, diuretics and beta-blockers, to prevent dizziness. To learn more, read: Drugs for the Treatment of Ménière's Syndrome.
- Sound therapy.
- The use of hearing aids, for the treatment of tinnitus.
- Physiotherapy, for the improvement of balance skills.
- The use of hearing aids.
Central Vertigo: How is it Cured?
Since migraine is the leading cause of central vertigo, in this section we will limit ourselves to a quick description of the treatment envisaged in this circumstance.
The treatment of migraine generally involves the administration of a series of drugs, to relieve painful symptoms and to prevent headache attacks.
To learn more about medicines useful in the management of migraines, we recommend reading the article here.
Other insights:
- Treatments and medications for the treatment of multiple sclerosis.
- Stroke treatment and medication.
- Cures and medications for the treatment of TIA.
Vertigo: What to Do During an Attack?
Generally, during a dizziness attack, it is advisable to lie down in a quiet, dimly lit room. This should lessen the sensation of the spinning environment and also the nausea.
Vertigo: What to Do to Prevent / Avoid Worsening Symptoms?
Typically, to prevent or avoid worsening dizziness, doctors recommend avoiding stressful and anxiety-causing situations as much as possible.
