Vertigo (medical)

Vertigo, a specific type of dizziness, is a major symptom of a balance disorder. It is the sensation of spinning while the body is stationary with lots to the earth or surroundings. With the eyes shut, there will be a sensation that the body is in movement, called subjective vertigo; if the eyes are open, the surroundings will appear to move past the field of vision, called objective vertigo.

The effects may be slight. It can cause nausea and vomiting or, if severe, may give rise to difficulty with standing and walking. Vertigo is usually associated with a problem in the inner ear balance mechanisms (vestibular system), in the brain, or with the nerve connections between these two organs. The most common cause is benign paroxysmal positional vertigo, or BPPV. Vertigo can be a symptom of an underlying harmless cause, such as in BPPV or it can suggest more serious problems. These include drug toxicities, strokes or tumors (though these are much less common than BPPV). Vertigo can also be brought on suddenly through various actions or incidents, such as skull fractures, sudden changes of blood pressure, or as a symptom of motion sickness while sailing, riding amusement rides or in a vehicle.[1]

Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings.

• Peripheral vertigo: The lesions, or the damaged areas, affect the inner ear or the vestibular division of the acoustic (CN VIII) nerve. Vertigo that is peripheral in origin tends to be felt as more severe than central vertigo, intermittent in timing, always associated with nystagmus in the horizontal plane and occasionally hearing loss or tinnitus (ringing of the ears).

• Peripheral vertigo can be caused by BPPV, Ménière's disease or acute vestibular neuronitis. Peripheral vertigo, compared to the central type, though subjectively felt as more severe, is usually from a less serious cause.

• Central vertigo: The lesions in central vertigo involve the brainstem vestibular nerve nuclei. Central vertigo is typically described as constant in timing, less severe in nature and occasionally with nystagmus that can be multi-directional. Associated symptoms include motor or sensory deficits, dysarthria (slurred speech) or ataxia.

• Causes include things such as migraines, multiple sclerosis or tumors. Less commonly, strokes, seizures, trauma or infections can cause also central vertigo.

• Vertigo should not be confused with dizziness. Dizziness is an unpleasant feeling of light-headedness, giddiness or fuzziness often accompanied by nausea.
• Vertigo is often incorrectly used to describe a fear of heights.
• Vertigo is often experienced when breathing helium, as a result of decreased oxygen flow to the brain.

• Klinefelter's Syndrome people with this condition - have enhanced spatial thinking capabilities, so might be more susceptible to vertigo - research is ongoing. (for more information see reference to http://www.xxytalk.com in links below).

Vertigo in context with the cervical spine

In some cases ligamental injuries of the upper cervical spine result in head-neck-joint instabilities which can cause vertigo. Instabilities of the head neck joint are affected by rupture or overstretching of the alar ligaments and/or capsule structures mostly caused by whiplash or similar biomechanical movements. If patients describe prolonged vertigo after a whiplash trauma, professionals should think about ligamental damage of head-neck-joint structures.

Symptoms during damaged alar ligaments besides vertigo often are

• dizziness
• reduced vigilance, such as somnolence
• seeing problems, such as seeing "stars", tunnel views or double contures.
• Some patients tell about unreal feelings that stands in correlation with:
• depersonalisation and attentual alterations

Most medical professionals don't know about the disease complex of head-neck-joint instabilities. Often the patients are having an odyssey of medical consultations without any clear diagnosis and are then sent to psychatrist because doctors think about depression or hypochondry. Standard imaging technologies such as CAT or MRI are not capable of finding instabilities without taking functional poses.

• The multitude of problems occurring after whiplash injury
• Head-neck-joint instability causality and interventional strategies
• Symptoms linked to head-neck-joint injuries
• Head-neck-joint injury interventional resources
• Collection of whiplash injury related documents

Causes of Vertigo

Inner ear

• benign paroxysmal positional vertigo
• labyrinthitis and vestibular neuronitis
• Ménière's disease
• perilymphatic fistula
• neurinoma of the acoustic nerve

Central nervous system

• posterior fossa neoplasm
• concussion
• migraine
• multiple sclerosis
• posterior circulation stroke

See also

• Alternobaric vertigo

References

What is Vertigo?

Dizzy: What You Need to Know About Managing and Treating Balance Disorders, by Jack J. Wazen with Deborah Mitchell. Simon & Schuster, 2004.

Feeling Dizzy: Understanding and Treating Vertigo, Dizziness, and Other Balance Disorders, by Brian W. Blakley and Mary-Ellen Siegel. Macmillan USA, 1995.

Vertigo and Dizziness, by Lucy Yardley. Routledge, 1994. Available as a free download at Meniere's Society UK website. Menieres Society rumjal 13:38, 23 March 2007 (UTC)

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