Vertigo and dizziness symptoms
Vertigo is a multisensory symptom that causes patients to feel as though they or their surroundings are moving, even when there is no actual movement taking place. The primary symptom is vertigo itself, which is characterised by a sensation of rotation that can sometimes be likened to the movement of a clock hand. When experiencing vertigo, patients can often identify the direction of the sensation. Vertigo is typically associated with peripheral vestibular disorders, which originate in the inner ear; however, it is not exclusively a symptom of these conditions. Another key symptom is dizziness, which does not involve a rotational sensation or a clearly identified direction. Patients may describe dizziness in various ways, including feelings of unsteadiness, instability, reeling, wobbling, leaning, or tilting. It is important to note that terms like ‘presyncope’ and ‘lightheadedness’ are outdated and not commonly used in current medical practice related to vertigo. In addition to vertigo and dizziness, there are other important features related to these symptoms that should be considered, which will be discussed in the following sections.
Duration of Vertigo Attacks: What Essential Information Does it Contain?
The duration of vertigo attacks can vary significantly, ranging from just a few seconds to constant symptoms. This information is essential for the examining doctor, making it important for patients to track the exact duration of their vertigo episodes. Additionally, the length of these attacks can directly affect a patient’s quality of life. For instance, brief vertigo episodes lasting only a few seconds are often characteristic of Benign Paroxysmal Positional Vertigo (BPPV), but they may also stem from other conditions. Conversely, vertigo that lasts for several hours is typically associated with Ménière’s disease, although longer episodes can also occur in cases of vestibular migraine and other disorders. Though the duration of vertigo attacks alone is not enough to provide a definitive diagnosis, it does offer crucial information for evaluation. Keeping a diary to record the duration of vertigo episodes can be beneficial during medical examinations.
Other Symptoms Related to Vertigo
When considering vertigo and dizziness, there are several other symptoms that are commonly observed. These accompanying symptoms are crucial for both diagnosis and differential diagnosis. Cochlear symptoms, such as hearing loss and tinnitus, are important indicators for both peripheral and central vestibular disorders. While these symptoms are particularly significant in the context of Ménière’s disease, they can also arise from other inner ear disorders. It is essential to remember that, along with vertigo, tinnitus, and hearing loss, one should consider potential central nervous system causes, such as a posterior circulation stroke. Analysing the relationship between vertigo and cochlear symptoms is therefore vital for healthcare providers. Ear blockage may also indicate inner ear disorders; however, it can have many other potential causes. In the acute phase of vertigo, symptoms such as nausea and vomiting often occur, making symptomatic treatment of these issues an important aspect of patient care. These symptoms can significantly impact the quality of life for patients. Additionally, headaches frequently accompany these conditions and may be related to migraines, but they can occur in a variety of other situations as well. Given the complex nature of vertigo, it is common for various other symptoms to co-occur.
Causes of Vertigo: An Overview
Vertigo is a complex condition that can stem from various organs in the body. When considering balance, three primary systems are involved: the vestibular system, the somatosensory system, and vision. Additionally, the movement system plays a crucial role in relation to vertigo. These systems are interconnected with many other parts of the body, meaning that vestibular symptoms can arise from multiple locations. Vestibular dysfunctions can be categorised into two main groups: central and peripheral disorders. One of the most common peripheral conditions is Benign Paroxysmal Positional Vertigo (BPPV), which occurs due to the dislocation of calcium carbonate crystals, vital components for maintaining balance. Another frequent cause is Ménière’s disease, characterised by the overproduction of inner ear fluid, known as endolymphatic hydrops. This disorder is quite complex and requires experienced management. Vestibular neuritis is another common issue, marked by inflammation of the vestibular nerve. In the acute phase of vestibular neuritis, it is essential to differentiate it from a stroke since both can manifest similar symptoms. When considering central vertigo, various factors may be involved, including circulation problems, stroke, multiple sclerosis, neurodegenerative diseases, and psychiatric conditions—these are among the more common causes. It is also important to note that not all cases of vertigo and dizziness are directly related to vestibular system dysfunctions. Other examples include cardiovascular issues, movement system problems, and visual impairments. As such, careful evaluation may necessitate rheumatological, orthopedic, or cardiological assessments, depending on the underlying cause.
Examinations for Vertigo Symptoms
Due to the complex nature of vertigo, a multidisciplinary approach is essential for each case. The first question to address is whether a vestibular origin can be identified as the cause of vertigo and dizziness. To determine this, specific vestibular examinations are required. One of the most important objective signs of vestibular dysfunction is the rhythmic movement of the eyes, known as nystagmus. While an experienced examiner can observe nystagmus during a physical examination, there are additional objective methods to assess it. Furthermore, various other vestibular tests are available, which should ideally be performed by a doctor specialised in neurotological evaluations. Modern testing techniques, such as caloric testing and video-head impulse testing, assist in the objective detection of vestibular dysfunction. In many instances, further examinations are necessary, including brain MRI, audiometry, or laboratory tests. Given the diverse causes of vertigo and dizziness, additional examinations may be warranted based on the suspected underlying cause.
Treatment Options for Vertigo
To determine the most appropriate treatment for vertigo, it is essential to identify its underlying cause, as effective therapies depend on the origin of the symptoms. Therefore, a thorough examination should always be the first step. There is no single ‘wonder drug’ that works for every case of vertigo. While the Epley manoeuvre, shown in the accompanying image, is crucial for treating Benign Paroxysmal Positional Vertigo (BPPV), it is not effective for all types of vertigo. It is important not to attempt this manoeuvre without a specific diagnosis that explains your vertigo. In addition, without guidance from a specialist, you may miss key details about performing the manoeuvre correctly. Many treatment options are available for vertigo, but the effectiveness of these medications varies significantly based on the cause of the symptoms. Dosing may also differ for each case. If the vertigo is not related to the vestibular system, a different treatment approach is necessary, which may involve consultation with other specialists. Finally, do not underestimate the importance of vestibular rehabilitation training in managing symptoms.
If you have vertigo and dizziness, do not hesitate to ask for an appointment!
András Molnár MD, PhD
Otorhinolaryngologist, Neurotologist, Tinnitus specialist
