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Vertigo

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Vertigo is a specific sensation of movement when a person is actually stationary. It often feels like the world is spinning or swaying around the individual. This sensation is different from general dizziness and is the most common type of dizziness reported. Vertigo can cause several physical reactions, such as nausea, vomiting, and perspiration. It often makes walking difficult and typically worsens when a person moves their head.

This condition is quite common in the general population. Approximately 7.5% to 10% of people experience vertigo at some point. About 5% of people experience it within any given year. It is more frequent in women and becomes more common as people age.

Medical professionals classify vertigo based on where the dysfunction is located. The first category is peripheral vertigo, which involves the vestibular system in the inner ear. This system includes the semicircular canals, the vestibule, and the vestibular nerve. The second category is central vertigo, which arises from the central nervous system. This means the issue is located in the brain or the brainstem, such as the cerebellum.

Doctors also use other classifications, such as objective vertigo, where stationary objects seem to move. Subjective vertigo is when the person feels they are moving themselves. Pseudovertigo is an intense feeling of rotation inside the person's own head.

Peripheral vertigo is often caused by issues within the inner ear structures. Benign paroxysmal positional vertigo, or BPPV, is the most frequent cause. BPPV accounts for 32% of all peripheral vertigo cases. It occurs when tiny pieces of calcium carbonate break off from the otoconial membrane. These pieces enter a semicircular canal and create a false sensation of motion.

Other peripheral causes include Ménière's disease, which accounts for 12% of cases. This disease may involve an increase in endolymphatic fluid within the ear. Vestibular neuritis is another cause, often linked to viral infections of the inner ear. This condition can cause vertigo that lasts for several days.

Central vertigo is generally more serious and involves the central nervous system. It can be caused by lesions in the brainstem or the cerebellum. Common causes include strokes, brain tumors, or multiple sclerosis. Central vertigo may also result from migraines or epilepsy. Unlike peripheral vertigo, central vertigo may not improve quickly. It is often associated with more severe neurological deficits. These can include slurred speech, double vision, or numbness.

In some cases, the imbalance is so severe that people cannot stand or walk.

To diagnose vertigo, doctors use several specialized medical tests. They often look for nystagmus, which is a period of rapid, involuntary eye movements. The Dix-Hallpike maneuver is a common test used to identify BPPV. For more complex cases, doctors might use the HINTS test at the bedside. This test combines three specific physical examinations to differentiate between central and peripheral causes.

Other tools include electronystagmography (ENG) to study eye movements. Doctors may also use CT scans or MRIs to look at the brain. To check hearing, they might use pure tone audiometry or other auditory tests.

Neurochemistry plays a major role in how the body processes balance. There is a three-neuron arc that drives the vestibulo-ocular reflex, or VOR. This reflex helps the eyes stay steady during head movement. Six primary neurotransmitters are involved in this process. Glutamate helps maintain the resting discharge of vestibular neurons. Acetylcholine acts as an excitatory signal in both peripheral and central synapses.

GABA is thought to be an inhibitory neurotransmitter in certain parts of the system. Other chemicals like dopamine and norepinephrine help the brain compensate for balance issues.

Understanding vertigo helps connect the study of the ears to the study of the brain. It shows how the vestibular system must communicate perfectly with the central nervous system. When this communication breaks down, the sensation of movement occurs. This connection is vital for maintaining posture and stability. Whether the cause is a tiny piece of calcium or a brain lesion, the result is a disruption of our sense of place in the world.

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