Vertigo

Basics

Description

Vertigo is a symptom, a sensation of perceived motion (“room spinning”) when no motion is happening, whereas dizziness is a disturbance of orientation without movement.

  • One of 4 types of dizziness (vertigo, presyncope, lightheadedness, disequilibrium)

Epidemiology

Incidence

The 1-year incidence for new onset vertigo was 1.4%; incidence in women nearly twice that of men (1).Geriatric Considerations

  • High index of suspicion for cardiovascular disease, neurologic disorders, arrhythmias, and orthostatic hypotension (2)
  • Benign paroxysmal positional vertigo (BPPV) is more common in ages 50 to 70 years, possibly due to the aging inner ear and otoconia degeneration (2).
  • Medications implicated 1/4 of the time (3).

Prevalence

The lifetime prevalence of vertigo in adults aged 18 to 79 years was 7.4%, with a one-year prevalence of 4.9%. Prevalence was two to three times higher in women than men, and three times higher in the elderly (1).

Etiology and Pathophysiology

  • Dysfunction of the rotational velocity sensors of the inner ear results in asymmetric central processing: a combination of sensory disturbance of motion and malfunction of the central vestibular apparatus (3).
  • Peripheral causes: acute vestibular neuritis, BPPV caused by loose canaliths getting stuck in the posterior canal (85–95%) and lateral canal (5–15%), Ménière disease, otosclerosis, acute labyrinthitis, cholesteatoma, perilymphatic fistula, superior canal dehiscence syndrome, motion sickness.
  • Central causes: cerebellar tumor, vestibular schwannoma, stroke, migraine, vertebrobasilar ischemia (3)
  • Numerous drug causes such as aminoglycosides (3)

Genetics

Unclear

Risk Factors

  • History of migraines
  • History of CVD/risk factors for CVD
  • Use of ototoxic medications
  • Trauma/barotrauma/heavy weightlifting
  • Psychosocial stress/depression
  • Exposure to toxins

General Prevention

If due to motion sickness, consider pretreatment with anticholinergics, such as meclizine, scopolamine.

Commonly Associated Conditions

  • Hypertension
  • Hyperlipidemia
  • Multiple sclerosis

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