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Vertigo
Classification and external resources
ICD-10	H81, R42
ICD-9	438.85, 780.4
eMedicine	neuro/
MeSH	D014717

Vertigo (from the Latin vertigin-, vertigo, "dizziness," originally "a whirling or spinning movement," from vertō "I turn"^[1]) is a specific type of dizziness, a major symptom of a balance disorder. It is the sensation of spinning or swaying while the body is actually stationary with respect to the surroundings.

The effects of vertigo may be slight. It can cause nausea and vomiting and, in severe cases, it may give rise to difficulties with standing and walking.

Vertigo is qualified as height vertigo when referring to dizziness triggered by heights.^{[citation needed]} "Vertigo" is often used, incorrectly, to describe the fear of heights, but the correct term for this is acrophobia.

Contents 1 Classification 1.1 Peripheral 1.2 Central 1.3 Other/ungrouped 2 Neurochemistry 3 Diagnostic testing 4 Treatment 5 References 6 External links

[edit] Classification

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Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway.^[2] These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings.

[edit] Peripheral

If the vertigo arises from the inner ear, it is severe and has associated nausea and vomiting. One common cause of otologic vertigo is benign paroxysmal positional vertigo (BPPV). Alternate causes of vertigo originating from the inner ear include Ménière's disease, superior canal dehiscence syndrome, and labyrinthitis.

Vertigo is usually associated with a problem in the inner ear balance mechanisms (vestibular system), in the syndrome and Meniere's disease.

Transient vertigo can be caused by inflammation of the inner ear due to the common cold, influenza, and bacterial infections.

[edit] Central

Migraine headaches can also cause vertigo.

Central vertigo can also be caused by lateral medullary syndrome.

Vertigo is also a symptom of other illnesses such as multiple sclerosis.

If vertigo arises from the balance centers of the brain, it is milder, and has accompanying neurologic deficits, such as slurred speech, double vision or nystagmus. Alternately, brain pathology can cause a sensation of disequilibrium which is an off-balance sensation.

Discontinuation of antidepressant medication, also known as selective serotonin reuptake inhibitor discontinuation syndrome can result in a wide variety of withdrawal symptoms. Vertigo is a frequently found symptom, along with brain shivers, insomnia, nausea, confusion, imbalance, sweating, and many more as withdrawal symptoms are different for each individual.^{[citation needed]}

[edit] Other/ungrouped

Vertigo can also occur after long flights or boat journeys where the mind gets used to turbulence, resulting in a person's feeling as if he or she is moving up and down. This usually subsides after a few days. Another source of vertigo is through exposure to high levels of sound pressure, rattling the inner ear and causing a loss of balance.^{[citation needed]}

Rarely, vertigo-like symptoms may appear as paraneoplastic syndrome (PNS) in the form of opsoclonus myoclonus syndrome, an extremely rare multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses.

Also, it has been reported that Vertigo can be triggered by constant stress which continues over a long period of time. Constant high levels of stress can change the brain chemicals of Serotonin, Norepinephrine, and possibly Dopamine, causing vertigo symptoms such as: feeling like the room is spinning even when you're lying down, nystagmus, where your eyes have a rapid movement, difficulty focusing your eyes, difficulty concentrating, possible nausea, and anxiety. SSRI's that affect these brain chemicals, have been shown to relieve the vertigo symptoms of this particular type of vertigo.^{[citation needed]}

[edit] Neurochemistry

The neurochemistry of vertigo includes 6 primary neurotransmitters that have been identified between the 3-neuron arc that drives the vestibulo-ocular reflex (VOR). Many others play more minor roles.

Three neurotransmitters that work peripherally and centrally include glutamate, acetylcholine, and GABA.

Glutamate maintains the resting discharge of the central vestibular neurons, and may modulate synaptic transmission in all 3 neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. GABA is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells and the lateral vestibular nucleus, and the vertical VOR.

Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. It is known that centrally acting antihistamines modulate the symptoms of motion sickness.

The neurochemistry of emesis overlaps with the neurochemistry of motion sickness and vertigo. Acetylcholine, histamine, and dopamine are excitatory neurotransmitters, working centrally on the control of emesis. GABA inhibits central emesis reflexes. Serotonin is involved in central and peripheral control of emesis but has little influence on vertigo and motion sickness.

[edit] Diagnostic testing

Tests of vestibular system (balance) function include electronystagmography (ENG), rotation tests, caloric reflex test,^[3] and computerized dynamic posturography (CDP).

Tests of auditory system (hearing) function include pure-tone audiometry, speech audiometry, acoustic-reflex, electrocochleography (ECoG), otoacoustic emissions (OAE), and auditory brainstem response test (ABR; also known as BER, BSER, or BAER).

Other diagnostic tests include magnetic resonance imaging (MRI) and computerized axial tomography (CAT or CT).

[edit] Treatment

Treatment is specific for the underlying cause of vertigo:

• vestibular rehabilitation
• anticholinergics
• antihistamines
• benzodiazepines
• calcium channel antagonists, specifically Verapamil and Nimodipine
• GABA modulators, specifically gabapentin and baclofen
• neurotransmitter reuptake inhibitors such as SSRIs, SNRIs and tricyclics
• benign paroxysmal positional vertigo (BPPV), a special kind of vertigo, is treated with the Epley maneuver (performed by a doctor or physical therapist, or with a BPPV maneuver at home)
• antibiotics if the underlying cause is inflammation of the inner ear due to bacterial infection.
• LASER treatment

[edit] References

[edit] External links

• Vertigo (medical) at the Open Directory Project

v • d • e Diseases of the ear and mastoid process (H60-H99, 380-389) External ear Otitis externa Middle ear and mastoid Otitis media · Mastoiditis (Bezold's abscess, Gradenigo's syndrome) Cholesteatoma · Perforated eardrum Inner ear and central pathways Common pathway Labyrinthitis/Otitis interna Equilibrioception Vertigo/Balance disorder: peripheral (Ménière's disease, BPPV, Vestibular neuronitis, Perilymph fistula) · central (Central positional nystagmus) Hearing Hearing impairment Conductive hearing loss (Otosclerosis, Superior canal dehiscence) · Sensorineural hearing loss (Presbycusis, Central hearing loss) Excessive response Tinnitus · Hyperacusis/Phonophobia Deafblindness Wolfram syndrome · Usher syndrome Other Acquired auditory processing disorder ear navs: anat/pathways/physio/dev, noncongen/congen, eponymous signs, proc

v • d • e Symptoms and signs: cognition, perception, emotional state and behaviour (R40-R46, 780.0-780.5,781.1) Cognition Alteration of consciousness Confusion (Delirium) · Somnolence · Obtundation · Stupor · Unconsciousness (Syncope, Coma, Persistent vegetative state) Fainting/Syncope Carotid sinus syncope • Heat syncope • Vasovagal episode Other Amnesia (Anterograde amnesia, Retrograde amnesia) · Dizziness (Vertigo, Presyncope/Lightheadedness, Disequilibrium) · Convulsion Emotional state Anxiety · Irritability · Hostility · Suicidal ideation Behavior Verbosity Perception/ sensation disorder Olfaction : Anosmia · Hyposmia · Dysosmia · Parosmia · Hyperosmia Taste: Ageusia · Hypogeusia · Dysgeusia  · Parageusia · Hypergeusia Hallucination: Auditory hallucination psychology navs: mental processes, disorders, symptoms/signs, speech/voice, psychotherapy olfaction navs: anatomy, symptoms/signs taste navs: anatomy, symptoms/signs