Vertigo

Vertigo: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)

Vertigo is an illusion of movement in which the patient feels that he’s revolving in space (subjective vertigo) or that his surroundings are revolving around him (objective vertigo). He may complain of feeling pulled sideways, as though drawn by a magnet.

A common symptom, vertigo usually begins abruptly and may be temporary or permanent and mild or severe. It may worsen when the patient moves and subside when he lies down. It’s commonly confused with dizziness—a sensation of imbalance and light-headedness that is nonspecific. However, unlike dizziness, vertigo is commonly accompanied by nausea, vomiting, nystagmus, and tinnitus or hearing loss. Although the patient’s limb coordination is unaffected, he may exhibit a vertiginous gait.

Vertigo may result from a neurologic or otologic disorder that affects the equilibratory apparatus (the vestibule, semicircular canals, eighth cranial nerve, vestibular nuclei in the brain stem and their temporal lobe connections, and eyes). However, this symptom may also result from alcohol intoxication, hyperventilation, postural changes (benign postural vertigo), and the effects of certain drugs, tests, or procedures.

History and physical examination

Ask your patient to describe the onset and duration of his vertigo, being careful to distinguish this symptom from dizziness. Does he feel that he’s moving or that his surroundings are moving around him? How often do the attacks occur? Do they follow position changes, or are they unpredictable? Find out if the patient can walk during an attack, if he leans to one side, and if he’s ever fallen. Ask if he experiences motion sickness and if he prefers one position during an attack. Obtain a recent drug history, and note any evidence of alcohol abuse.

Perform a neurologic assessment, focusing particularly on eighth cranial nerve function. Observe the patient’s gait and posture for abnormalities.

Medical causes

Acoustic neuroma

This tumor of the eighth cranial nerve causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and—with cranial nerve compression—facial paralysis.

Benign positional vertigo

In this disorder, debris in a semicircular canal produces vertigo lasting a few minutes when the patient changes head position. This type of vertigo is usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

This condition produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after a head injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased level of consciousness. Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly in this inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

In this disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Motion sickness

This condition is characterized by vertigo, nausea, vomiting, and headache in response to rhythmic or erratic motions.

Multiple sclerosis (MS)

Episodic vertigo may occur early and become persistent in MS. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Posterior fossa tumor

This type of tumor may produce positional vertigo that lasts for a few seconds as well as papilledema, headache, memory loss, nausea, vomiting, nystagmus, apneustic or ataxic respirations, and increased blood pressure. The patient may also fall sideways.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis

In this disorder, severe vertigo usually begins abruptly, lasts several days, and isn’t accompanied by tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Administration of overly warm or cold eardrops or irrigating solutions can also cause vertigo.

Special considerations

Place the patient in a comfortable position, and monitor his vital signs and level of consciousness. Keep the side rails up if he’s in bed, or help him to a chair if he’s standing when vertigo occurs. Darken the room and keep him calm. Administer drugs to control nausea and vomiting and meclizine or dimenhydrinate to decrease labyrinthine irritability.

Prepare the patient for diagnostic tests, such as electronystagmography, EEG, and X-rays of the middle and inner ears.

Pediatric pointers

Ear infection is a common cause of vertigo in children. Vestibular neuritis may also cause this symptom.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

More About Syncope

• Back to disease: Syncope: Introduction
• Next Book Extract About Syncope: Syncope (Professional Guide to Signs & Symptoms (Fifth Edition))
• More Book Extracts: All Online Books for Syncope

More Medical Textbooks Online about Syncope

Review other book chapters online related to Syncope:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

 » Next page: Syncope (Professional Guide to Signs & Symptoms (Fifth Edition))

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Syncope (Professional Guide to Signs & Symptoms (Fifth Edition))
• Coma (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• Delirium (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• Dizziness (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• Vertigo (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City