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Vertigo

Vertigo is a sensation of abnormal motion, either of the surroundings or of the body; vertigo may be described as spinning, whirling, swaying, or as "the room is moving dizziness, meniere disease, Menière's Disease, menieres disease."

Differentiation of Central Causes of Vertigo from Peripheral Causes

Eighty-five percent of patients with vertigo have a peripheral vestibular disorder, 15% have a central nervous system disorder.

Peripheral disorders may have associated hearing loss and tinnitus, without other neurologic deficits. Vertigo from peripheral lesions often develops acutely and is intermittent and shorter-lasting; peripheral lesions tend to cause more severe vertigo with associated nausea and vomiting.

Central lesions, such as cerebral tumors, are not associated with hearing loss, but may be accompanied by other neurologic signs reflecting brain-stem involvement. Symptoms of central lesions develop more insidiously and are longer-lasting and more continuous; central lesions usually cause less severe vertigo and nausea virtigo, vertago.

Peripheral Causes of Vertigo

Benign positional vertigo is the most common cause of vertigo, occurring twice as frequently as any other vestibular disorder. Intense but brief episodes of vertigo are associated with changes in head position, usually when lying down. Symptoms resolve within 3-6 months, but may recur.

Neurologic examination is normal, except for positional nystagmus which is induced by rapid head movement.

Etiology. Symptoms may occur after trauma or viral infections. The majority of cases are idiopathic. The average age is 51 years with increased incidence with advancing age. The mechanism may be sediment falling on the cupula of the semicircular canal.

Hallpike maneuver confirms the diagnosis of BPV. The patient's head is rotated to one side and then gradually lowered to 30^° below the horizontal position. When the affected ear is in the downward position, nystagmus and vertigo is triggered after a few seconds.

Vestibular neuronitis is characterized by sudden severe vertigo, lasting up to 10 days. Nausea and vomiting are common; no hearing loss or neurologic signs are present. The disorder typically follows a dizziness, meniere's disease, Menière's Disease, Menier disease