Neurology Corner
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Understanding Vertigo & Dizziness
As vertigo and symptoms of dizziness are one of the top 5 reasons individuals seek medical
attention, I feel it is necessary to understand both the symptoms themselves, and what is
likely causing them. These frightening and often debilitating symptoms have many potential
causes, and proper assessment and diagnosis is essential to treating them effectively.
First we must understand the symptoms. Vertigo is derived from the Latin “vertere”, meaning
to turn. Vertigo is always associated with a sensation of turning or spinning, whether it is the
individual spinning, or the environment spinning around the individual. Most cases involve
the environment spinning around the individual, which is most often a less complicated
presentation.
Dizziness is often described as “lightheadedness” or feeling as if one is going to faint.
Spinning is typically not associated with dizziness.
Disequilibrium is a loss or alteration in our sense of balance, often associated with feelings
of being “on a boat” or the effects of alcohol on the way we walk and perceive ourselves
relative to the environment around us (“drunken gait”).
Nausea and/or vomiting often accompany vertigo and may, although less often, be
associated with dizziness and disequilibrium. Dizziness and disequilibrium typically do not
lead to vertigo, but untreated vertigo will often lead to complications with these two symptoms
due to compensatory changes within the nervous system.
There are many possible causes of vertigo, but, by far, the leading cause is related to debris
(otoconia) made up of calcium carbonate crystals that dislodge from their proper place within
the inner ear canal system. This condition, called Benign Paroxysmal Positional Vertigo
(BPPV), is due to the disruption of signals transmitted to the brain regarding angular
acceleration of the head from this debris in the affected ear canal. Fortunately this condition
is treated with great success via head positioning maneuvers designed to relocate the debris
to its proper location, followed by rehabilitation for the inner ear vestibular (balance) organs.
Aging and head trauma are the two main predisposing factors for BPPV. The one major
drawback is that this condition is often not assessed appropriately, therefore leading to an
incorrect diagnosis.
Other causes of vertigo include Vestibular Neuritis/Neuronitis, which, as its name implies,
involves inflammation of the inner ear. Although treated with anti-inflammatory agents,
symptoms often persist and require rehabilitation of inner ear vestibular organs. Meniere’s
Disease, which consists of a triad of symptoms including vertigo, tinnitus (ringing in the ears)
and progressive hearing loss, is caused by an increase in a certain type of fluid within the
inner ear causing pressure on balance and hearing centers. Considered a more ominous
and poorly understood condition, certain types of therapeutic interventions can be effective,
especially with regard to the vertigo component. Perilymph Fistula is a defect in the
membrane, or window, between the middle and inner ear causing pressure changes
affecting the inner ear. A certain class of antibiotic medications (aminoglycosides) can cause
damage to the eighth cranial nerve leading to vertigo and hearing loss.
As with vertigo there are many causes of dizziness, a list too exhaustive to explore here, but
many are related to medication side effects (it is one of, if not the most common medication
side effects across all classes of medications) and changes in heart rate and blood
pressure (Postural Hypotension and Vasovagal Syncope). Anxiety disorders and panic
attacks may lead to dizziness as well.
Disequilibrium is often related to alteration or disturbance in central (brain) feedback from
any of the major systems related to balance including visual, muscle and joint
(proprioceptive), and inner ear vestibular systems. The number of metabolic, physical and
functional conditions that may affect these systems is quite lengthy as you could imagine!
Alcohol, recreational and therapeutic drugs, and environmental exposures, among many
other triggering agents, can play a large role in disruption of equilibrium. As noted, untreated
vertigo will likely lead to symptoms of both dizziness and disequilibrium.
Treatment for all disorders is wide ranging and the effectiveness of any given treatment is
dependant upon the accurate diagnosis of the condition creating the symptoms. The bottom
line is that all conditions affecting balance will likely benefit from active rehabilitation of the
involved systems once the causative factor has been established. Although to the individual
experiencing these symptoms it appears that the prognosis is hopeless, long term
outcomes are favorable for the vast majority of conditions outlined! Diagnostic and treatment
interventions will be discussed in greater detail in a future article.
*Dr. Michael S. Trayford is a Board Certified Chiropractic Neurologist who has undergone
extensive training in diagnosis and management of vestibular/balance disorders and fall
prevention. He can be reached at 828.681.0350 or on the web at www.hamptonwellness.
com.
As vertigo and symptoms of dizziness are one of the top 5 reasons individuals seek medical
attention, I feel it is necessary to understand both the symptoms themselves, and what is
likely causing them. These frightening and often debilitating symptoms have many potential
causes, and proper assessment and diagnosis is essential to treating them effectively.
First we must understand the symptoms. Vertigo is derived from the Latin “vertere”, meaning
to turn. Vertigo is always associated with a sensation of turning or spinning, whether it is the
individual spinning, or the environment spinning around the individual. Most cases involve
the environment spinning around the individual, which is most often a less complicated
presentation.
Dizziness is often described as “lightheadedness” or feeling as if one is going to faint.
Spinning is typically not associated with dizziness.
Disequilibrium is a loss or alteration in our sense of balance, often associated with feelings
of being “on a boat” or the effects of alcohol on the way we walk and perceive ourselves
relative to the environment around us (“drunken gait”).
Nausea and/or vomiting often accompany vertigo and may, although less often, be
associated with dizziness and disequilibrium. Dizziness and disequilibrium typically do not
lead to vertigo, but untreated vertigo will often lead to complications with these two symptoms
due to compensatory changes within the nervous system.
There are many possible causes of vertigo, but, by far, the leading cause is related to debris
(otoconia) made up of calcium carbonate crystals that dislodge from their proper place within
the inner ear canal system. This condition, called Benign Paroxysmal Positional Vertigo
(BPPV), is due to the disruption of signals transmitted to the brain regarding angular
acceleration of the head from this debris in the affected ear canal. Fortunately this condition
is treated with great success via head positioning maneuvers designed to relocate the debris
to its proper location, followed by rehabilitation for the inner ear vestibular (balance) organs.
Aging and head trauma are the two main predisposing factors for BPPV. The one major
drawback is that this condition is often not assessed appropriately, therefore leading to an
incorrect diagnosis.
Other causes of vertigo include Vestibular Neuritis/Neuronitis, which, as its name implies,
involves inflammation of the inner ear. Although treated with anti-inflammatory agents,
symptoms often persist and require rehabilitation of inner ear vestibular organs. Meniere’s
Disease, which consists of a triad of symptoms including vertigo, tinnitus (ringing in the ears)
and progressive hearing loss, is caused by an increase in a certain type of fluid within the
inner ear causing pressure on balance and hearing centers. Considered a more ominous
and poorly understood condition, certain types of therapeutic interventions can be effective,
especially with regard to the vertigo component. Perilymph Fistula is a defect in the
membrane, or window, between the middle and inner ear causing pressure changes
affecting the inner ear. A certain class of antibiotic medications (aminoglycosides) can cause
damage to the eighth cranial nerve leading to vertigo and hearing loss.
As with vertigo there are many causes of dizziness, a list too exhaustive to explore here, but
many are related to medication side effects (it is one of, if not the most common medication
side effects across all classes of medications) and changes in heart rate and blood
pressure (Postural Hypotension and Vasovagal Syncope). Anxiety disorders and panic
attacks may lead to dizziness as well.
Disequilibrium is often related to alteration or disturbance in central (brain) feedback from
any of the major systems related to balance including visual, muscle and joint
(proprioceptive), and inner ear vestibular systems. The number of metabolic, physical and
functional conditions that may affect these systems is quite lengthy as you could imagine!
Alcohol, recreational and therapeutic drugs, and environmental exposures, among many
other triggering agents, can play a large role in disruption of equilibrium. As noted, untreated
vertigo will likely lead to symptoms of both dizziness and disequilibrium.
Treatment for all disorders is wide ranging and the effectiveness of any given treatment is
dependant upon the accurate diagnosis of the condition creating the symptoms. The bottom
line is that all conditions affecting balance will likely benefit from active rehabilitation of the
involved systems once the causative factor has been established. Although to the individual
experiencing these symptoms it appears that the prognosis is hopeless, long term
outcomes are favorable for the vast majority of conditions outlined! Diagnostic and treatment
interventions will be discussed in greater detail in a future article.
*Dr. Michael S. Trayford is a Board Certified Chiropractic Neurologist who has undergone
extensive training in diagnosis and management of vestibular/balance disorders and fall
prevention. He can be reached at 828.681.0350 or on the web at www.hamptonwellness.
com.