Miscellaneous causes of vertigo
Thursday, July 24, 2014
VERTIGO or DIZZINESS or GIDDINESS
What is vertigo?
Vertigo is a common symptom in patients presenting to neurology outpatient department. It is described as a sense of rotation (rotation of self or of the surroundings). Other terms to describe the same sensation are dizziness, giddiness, chakkar (in Hindi), tala tiragadam (in Telugu), etc.
What are the common symptoms in a patient with vertigo?
The most common feeling is a sense of rotation or imbalance. This feeling becomes more prominent while walking or moving. In some cases, even head or neck movements (such as getting up from lying down position or bending down to pick something) can aggravate the symptoms of dizziness. Other symptoms may include:
· Imbalance while walking,
· Blurred vision,
· Poor concentration.
What are the common causes of vertigo?
Vertigo can be caused by a variety of reasons. The more important of them include:
BPPV- benign paroxysmal positional vertigo
· In this condition, there is a problem in the inner ear. Calcium crystals get deposited in one of the semicircular canals.
· It can occur in all ages, and is common in adults and in older people. It affects 2.4% of population sometime in their lifetime.
· It is a benign condition, which means it is not life-threatening and it does not get worse over time,
· Symptoms are made worse with head or neck movements (positional symptoms),
· Symptoms occur intermittently,
· People may get better in 1-2 days, however, in some, it may last for a few months also,
· Head injury, concussion, migraine, etc may bring on the symptoms of BPPV
· Diagnosis is made on the basis of history and clinical examination. Hearing and vestibular tests may be helpful.
· Treatment consists of symptomatic treatment with antihistaminic medications such as betahistine tablets.
· Canal repositioning procedures done in office are helpful and can cure the condition, however, these procedures should be done by trained doctors,
· Vestibular adaptation exercises help in prevention of recurrent episodes of vertigo.
· In refractory cases, there may be a role for ear surgery.
Posterior circulation stroke (Brain stroke)
· This refers to reduction in blood supply to the back of brain, mainly cerebellum and brain stem.
· This is more common in people with risk factors for stroke, such as high blood pressure, diabetes, high cholesterol, smoking, etc.
· Patients often have additional symptoms such as double vision, slurred speech, difficulty in swallowing, imbalance while walking, etc. Isolated symptoms of vertigo without any additional symptoms, seldom/rarely occur due to brain stroke.
· The diagnosis can be confirmed by doing an MRI scan of brain.
· Treatment is done as for brain stroke (refer to my earlier blog articles on brain stroke management).
· This is an uncommon cause of vertigo,
· Occurs in the setting of severe cervical spondylosis and disc disease in the cervical (neck) region,
· Cervical vertigo is also more common in older people.
· Treatment is as for disc disease (refer to my earlier article on disc disease)
In addition to the above listed main causes of vertigo, we should also look for other causes. These include low blood pressure, anemia (low haemoglobin), general weakness, low blood sugars, etc.
Who should we consult for vertigo?
Initially, a primary care physician may be consulted. If there is a doubt in exact diagnosis, the patient should be evaluated by a neurologist.
An ENT opinion may be taken if an ear-related cause is suspected.
What is the outcome in cases of vertigo?
Most people with vertigo recover well and they do so in a few days. However, a minority of patients continue to suffer for several months. It is uncommon for the symptoms to last for more than three months.
Vertigo may be disabling in the first few days of illness, however, after that period, most people are able to normally function.
Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Phone (for appointment): 0091-40-23607777, extension 6634/3011
Online consultation: http://bit.ly/Dr-Sudhir-kumar