Vertigo is defined as sudden perception of rotational motion due to dysfunction of the system that maintains the balance of the body (vestibular system in inner ear and the brainstem). Dizziness is a collective term to describe situations ranging from feeling lightheaded or faint to feeling unsteady and weak. Vertigo and dizziness are common medical problems and affecting around 25% of the population at some time of their life. These are usually indicators of underlying problem rather than diseases themselves. Vertigo is more common among females than males and among the elderly population comparing to the young individuals.
Most of the time vertigo is short lasting and occur due to benign causes; but it has to be kept in mind that some serious conditions can also cause vertigo. Vertigo and dizziness due to any cause is the most frequently encountered reason of falls experienced specially by elderly individuals, sometimes with devastating results such as fractures, intra cranial hemorrhages and internal organ damage that may even cause death.
Vertigo can be broadly classified in to two groups
- Central vertigo
This arises due to a damage to balance center in the central nervous system. Usually accompanied with other neurological deficits but nausea and vomiting is less common comparing to peripheral vertigo. Prognosis is also poor in central vertigo comparing to peripheral vertigo. Common causes are:
- Infarction
- Hemorrhage
- Cerebello-pontine angle tumors
- Epilepsy
- Cervical spondylosis
- Parkinsonism
- Multiple sclerosis
- Peripheral vertigo-
Vertigo arises due to disorder in inner ear or vestibular system. Prognosis is good .Common causes are,
- Benign paroxysmal positional vertigo
- Meniere’s disease
- Laberinthitis
- Common cold
- Influenza
- Medications (e.g. aminoglycoside antibiotics – gentamicin…, loop diuretics – furosemide…and specially anti-hypertensive drugs – losartan, nifedipine, etc.)
- Skull fracture
- Motion sickness
Signs and symptoms:
- Spinning sensation
- Nausea
- Vomiting
- Unsteadiness
- Difficulty in walking
- Blurred vision
- Altered level of consciousness
- Tinnitus
- Hearing loss
- Sudden falls
First aid management:
- Lie down or sit before you fall.
- Help the patient to lie down; prevent impacting on to dangerous objects.
- Call for help.
- Avoid driving and other activities. Stop the vehicle safely if you get dizzy while driving.
- Provide calm and quiet environment, loosen up tight clothing and allow for good ventilation.
- Avoid bright lights and dark room is preferred.
- Observe the patient for fits, mouth deviation, paralysis of limbs and the level of consciousness. If any present/or if patient has fallen on ground, call for emergency services.
- If patient vomited turn to lateral side to prevent aspiration.
- If the patient is thirsty allow some water to drink after making sure that he/she can swallow it.
- Do not allow to stand up until full recovery and do so slowly and stepwise to see vertigo returns.
- If this is the first attack call your doctor for further evaluation.
- If persistent symptoms or different than previous attacks, better to contact your doctor.
- Try to identify the cause it may be useful for further management issues.
Prevention of vertigo
- Avoid sudden changes in posture.
- Before waking up from the bed; first relax your mind, get up slowly and in stepwise manner – sit on the bed and wait, put your legs down and wait for some time, then slowly get up on feet holding the bed and wait for few seconds before walking away.
- Avoid bending down and avoid neck extension. Use two pillows for sleeping.
- Drink much fluid.
- Inform your doctor about the condition if it’s severe, he may change medication.
- If you are suffering from ear infection, consult your doctor and take treatment for that and vertigo will disappear when infection is cured.
Pharmacological management of vertigo:
- Antihistamine – betahistine, dimenhydrinate, meclozine,
- Beta blockers – metoprolol
- Anticholinergics – scopolamine
- Anticonvulsants – topiramate, valproic acid
- Corticosteroids – methylprednisolone, dexamethasone