SHM's Clinical Quick Talks-Vertigo

Pdf Summary

Vertigo is the sensation of movement or rotation caused by vestibular system imbalance and is classified as central or peripheral. Central vertigo arises from central nervous system lesions, often in the brainstem or cerebellum, and is more associated with imbalance. Peripheral vertigo stems from inner ear or vestibular nerve disorders, linked to autonomic symptoms like nausea and auditory symptoms such as hearing loss or tinnitus.<br /><br />Common peripheral vertigo causes include:<br /><br />- Benign paroxysmal positional vertigo (BPPV): Brief episodes triggered by position changes due to canaliths in semicircular canals; diagnosed via Dix-Hallpike maneuver; treated with repositioning maneuvers (Epley, Semont-plus) and Brandt-Daroff exercises.<br />- Ménière’s disease: Recurrent vertigo lasting 20 minutes to hours with unilateral hearing loss, tinnitus, and ear fullness due to endolymphatic hydrops; managed by salt restriction, diuretics, intratympanic corticosteroids, or surgery.<br />- Vestibular neuritis: Acute vertigo with nausea and nystagmus, no hearing loss; caused by vestibular nerve inflammation; steroids aid recovery.<br />- Labyrinthitis: Similar to vestibular neuritis but includes hearing loss; usually viral.<br /><br />Common central vertigo causes include vascular insufficiency (vertebrobasilar ischemia), migraine-associated vertigo, multiple sclerosis, and tumors (cerebellopontine angle meningiomas). Treatments target underlying causes and may involve antiplatelet agents, migraine prophylaxis, disease-modifying therapies, or surgery.<br /><br />Evaluation includes detailed history, medication review, physical exam (notably nystagmus and Dix-Hallpike test), and imaging if neurological signs (e.g., unilateral hearing loss) are present. Symptomatic relief may involve vestibular suppressants like antiemetics, antihistamines, or benzodiazepines. The HINTS exam helps differentiate central versus peripheral vertigo. Medication toxicity is a common cause, especially in the elderly.

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Chloe Marie Jones, Nicole Terrigno

Keywords

Vertigo

Vestibular system imbalance

Central vertigo

Peripheral vertigo

Benign paroxysmal positional vertigo (BPPV)

Ménière’s disease

Vestibular neuritis

Labyrinthitis

HINTS exam

Dix-Hallpike maneuver