Objective:  Requested by one of the members- "One of my friends said that there were a lot of questions on vertigo. Could you put something together for the exam?"

Vertigo is a subjective sensation of spinning. It is not the same as lightheadedness which is a sensation of poor balance without spinning.

Vertigo can arise from many structures, the commonest of which are the following.

1. Inner ear (labyrinth) a.k.a. . Peripheral

2. Brain stem a.k.a. central.

Labyrinthine vertigo can be due to one of 7 common ailments.

  1. Acute labyrinthine vertigo typically comes as a result of viral illnesses. They are self limiting and are not associated with hearing loss, tinnitus or brain stem dysfunction. Nystagmus is present.
  2. Meniere's disease is a.k.a. chronic labyrinthine vertigo and is associated with age > 40, tinnitus, hearing loss, nausea and vomiting. It typically comes in short lasting episodes, but the tinnitus and hearing loss may persist between attacks.
  3. Toxins such as aspirin, other nonsteroidal drugs, Aminoglycosides and Vancomycin can cause vertigo in toxic levels.
  4. Head trauma can also lead to vertigo. This is usually self limited.
  5. Benign positional vertigo is characterized by vertigo that lasts approximately 10 seconds, associated with nystagmus, and most importantly is capable of being fatigued by repeated motions of the head. There is no tinnitus or loss of hearing. Treatment of this condition is done by physical therapy.
  6. Labyrinthine ischemia which is usually seen in the elderly can also lead to vertigo.
  7. Acoustic nerve lesions can cause poor balance, true vertigo being rare. There is usually associated dysfunction of other cranial nerves particularly 7th.

Central vertigo on the other hand, has one key finding and that is vertical nystagmus. Associated with this, one may find brain stem dysfunction for instance malfunction of another cranial nerve. MRI of the posterior fossa is useful.