Vertigo
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.
Other Book Chapters Related to Dizziness
Read excerpts from these other book chapters related to Dizziness:
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Dizziness
» Next page: Dizziness (Professional Guide to Signs & Symptoms (Fifth Edition))
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