Vertigo is the illusion of movement that can be referred by the person as if the world is moving. I write this blog to explain a little better about the possible causes, symptoms and treatments.
In order to understand vertigo, we must understand that the organ in charge of sensing the movement or position of our body is in the ear, it consists of several parts that include the utricle, the saccule and 3 semicircular canals. The latter contain a liquid that when moving, due to changes in position, is detected by tiny hairs inside the channels, this information travels through the vestibular nerve to the brain where it is analyzed to give the person the information of whether it is in movement or not.
When there is vertigo, some of the elements involved in the balance are altered so the sensation of movement is generated even if there is not.
What is vertigo?
Sometimes it is difficult for the patient to explain the feeling of vertigo since this symptom can be confused with other entities such as dizziness, nausea, presyncopes or imbalance. However, vertigo is the illusion of movement that can be referred by the person as if the world is moving.
Up to 30% of people over 65 years of age suffer from this condition and 5% of emergency department visits are for this condition.
What are the most common causes of vertigo?
There are multiple causes of vertigo which include:
- Vestibular neuritis
- Benign paroxysmal vertigo
- Meniere’s syndrome
- And other less frequent causes
In the following of the blog we will give the most typical data of each entity and their management, however, the diagnosis must always be made by your treating physician. Remember that whenever you want to cut your hair you go to the barbershop and you do not do it yourself because it can be sheared, imagine now with something that can be life or death.
What is it and what are the symptoms of benign paroxysmal vertigo?
Purely clinical diagnostic disease, your doctor may find the Dix-Hallpike maneuver positive. It is more common in women over 50 years of age. It presents as episodes of vertigo that appear with changes in the position of the head, usually with a maximum duration of 5 minutes and are rarely accompanied by nausea or vomiting. Remember that it is not associated with hearing impairments such as hearing loss (hearing loss), ringing in the ears (tinnitus) or a feeling of a blocked ear (aural fullness).
It is believed to be secondary to something called canalolithiasis (presence of small pebbles, otoliths, within the balance sensing organs (semicircular canals).
Treatment consists of vestibular sedatives, antiemetics, and the Epley or Barbecue repositioning maneuvers (these consist of sudden head movements performed by your physician to relocate the otoliths to a site that does not cause vertigo). Despite proper management the disease can reappear over time, it is your obligation to recognize the symptoms and attend your treating doctor in time.
What is and what are the symptoms of vestibular neuritis?
Clinical diagnosis disease, which implies that there is no test to confirm it, just the symptoms referred by the patient. It usually occurs in young people, without a history of disease. It is caused by inflammation of the nerve involved in the balance (vestibular nerve) secondary to viral or bacterial infections. It is not associated with hearing disorders but there may be nausea, vomiting, and marked imbalance.
El manejo que se da es para los síntomas, con sedantes vestibulares (mejoran la sensación de movimiento), corticoides (modulan la inflamación) y antieméticos (mejoran la náusea y el vómito). Con el tiempo el nervio se va ir desinflamando lo que puede durar hasta 2 meses, sin embargo, el vértigo usualmente mejora en los primeros 3 a 6 días con algo de persistencia de desequilibrio por unas semanas más. En ocasiones puede ser un factor predisponente para el vértigo paroxístico benigno.
What is and what are the symptoms of Meniere’s syndrome?
The diagnosis is based on the clinic but hearing alterations can be confirmed with tests. It is the presence of hearing loss, tinnitus and vertigo, it can be accompanied by aural fullness, the episodes can last for hours, 80% of cases are unilateral and can appear between 20-50 years of life.
The cause is suspected to be an increased pressure in the fluid within the semicircular canals.
Treatment consists of the use of antiemetics, vestibular sedatives, and diuretics (they make the person urinate more). The restriction of salt in the diet (less than 1g per day) is also recommended. In severe cases, surgical procedures can be performed to decompress the semicircular canals.
What other causes of vertigo are there?
There are a lot of causes of vertigo ranging from normal aging (presbystasis), acute otitis media, Ramsay Hunt syndrome, migraine, medications, and the most dangerous of all, strokes. The latter is the reason why you should not self-diagnose and whenever you have vertigo you should see your doctor.
What should I do as medical personnel?
Your obligation as a person without medical knowledge is to attend your medical service if you present symptoms and try to describe your symptoms as clearly as possible including:
- Moment when the symptoms started
- Symptoms that accompany vertigo (very important especially if there are neurological symptoms)
- Previous episodes
- Medications you are currently taking
Recommendations for medical personnel
Remember that whenever you meet a person with acute vertiginous syndrome, the HINTS evaluation form the terms “head impulse test, nystagmus directionality, and test of skew” should be performed, which can be performed at the first evaluation of the patient and is used to rule out cerebrovascular accident, being more sensitive than magnetic resonance imaging in the first 72 hours of the condition.
In conclusion, we could say that vertigo is an entity with multiple causes, that the diagnosis will be made by your doctor according to your symptoms and your obligation as a patient should be to describe the symptoms as clearly as possible. Remembering that in most cases the treatment is symptomatic, since the disease will resolve itself.
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- Hanley, K., O’Dowd, T., & Considine, N. (2001). A systematic review of vertigo in primary care. British journal of general practice, 51(469), 666-671 https://bjgp.org/content/51/469/666.short
- Harari Masri, N., & Roa Castro, F. (2019). Vértigo: revisión de los principales trastornos periféricos y centrales. Anales Médicos de la Asociación Médica del Centro Médico ABC, 64(4), 290-296. https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=90440
- Fernández, L., Breinbauer, H. A., & Delano, P. H. (2015). Vertigo and dizziness in the elderly. Frontiers in neurology, 6, 144. https://www.frontiersin.org/articles/10.3389/fneur.2015.00144/full
- Imágenes: https://pixabay.com/es/photos/escalera-caracol-espiral-v%C3%A9rtigo-2813946/
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