Vertigo

Vertigo is a false feeling that you or your surroundings are spinning or moving, even when you are still. It is a symptom rather than a disease, and it most often comes from a problem in the inner ear, which controls balance. Less commonly, vertigo is caused by a problem in the brain, such as a stroke or tumour, and these causes need prompt attention.

Symptoms

• A spinning sensation, often brought on by moving the head, turning in bed or looking up
• Loss of balance, unsteadiness or a tendency to fall
• Nausea and vomiting
• Abnormal jerking movements of the eyes
• Sweating and a feeling of weakness
• Ringing in the ear, a feeling of fullness or reduced hearing in some inner ear conditions

Causes

• BPPV (benign paroxysmal positional vertigo): tiny crystals in the inner ear move out of place, causing brief spinning with head movements. This is the most common cause.
• Vestibular neuritis or labyrinthitis: inflammation of the balance nerve or inner ear, usually after a viral infection
• Meniere's disease: attacks of vertigo with hearing loss, ringing and ear fullness
• Vestibular migraine: vertigo linked to migraine
• Stroke or reduced blood flow to the back of the brain
• Tumours near the balance nerve, such as a vestibular schwannoma (acoustic neuroma), or in the back of the brain
• Less often, side effects of medicines or low blood pressure

Diagnosis

Diagnosis starts with a detailed history and examination, including tests of eye movements, balance and walking, and simple position-change tests that can bring on BPPV. Hearing tests may be advised. An MRI of the brain is needed if there are signs pointing to a brain cause, if there is hearing loss in one ear, or if vertigo does not settle as expected. Blood pressure, blood sugar and other blood tests may also be checked.

Treatment

Most vertigo is treated without surgery. BPPV is usually treated with simple repositioning manoeuvres done in the clinic, and patients may be taught exercises to continue at home. Short courses of medicines can ease nausea and spinning during an acute attack, but they are not meant for long-term use because they can slow the brain's natural recovery of balance. Balance (vestibular) exercises help many people recover fully. Inner ear conditions may be managed together with an ENT specialist.

A neurosurgeon's role is to rule out serious brain causes and to treat conditions such as tumours near the balance nerve or in the back of the brain. These are uncommon, and treatment, which may include monitoring with scans, surgery or radiation, depends on the size and type of the lesion seen on MRI.

When to Seek Urgent Care

• Vertigo with sudden weakness, numbness, slurred speech, facial droop, double vision or difficulty swallowing
• Inability to stand or walk
• Vertigo with a sudden severe headache or neck pain
• Vertigo after a head injury
• Sudden loss of hearing
• Vertigo with fainting, chest pain or a racing heartbeat
• Continuous vomiting with inability to keep fluids down

If you notice any of these, go to the nearest emergency immediately.

If you have repeated or persistent vertigo, consult Dr. Prashant Sharma for an evaluation to find the cause and plan the right treatment.

Related Conditions

• Head Injury
• Blood Clot in the Brain
• Brain Haemorrhage
• Brain Stroke
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