Vertigo (cont.)

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What are the symptoms of vertigo?

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While individuals may use the word dizziness, vertigo symptoms are described by the feeling that either the world is spinning around the person or that the person themselves is spinning. This is the same type of sensation that happens when a person quickly steps off a merry-go-round or when they twirl themselves and then quickly stop. The feeling of spinning may be associated with loss of balance to the point that the person walks unsteadily or falls down. The individual or family member may describe the person walking as if they were drunk. Vertigo itself is a symptom or indicator of an underlying balance problem, either involving the labyrinth of the inner ear or the cerebellum of the brain.

If other structures of the ear are involved, associated symptoms may include decreased hearing and ringing in the ear (tinnitus).

If there are issues with the cerebellum, the person may also complain of difficulty with coordination.

Nausea and vomiting are often associated symptoms with vertigo. Frequently, the more intense the vertigo, the more intense the nausea and vomiting become. These symptoms may be so severe that the individual becomes dehydrated and weak.

How is vertigo diagnosed?

Vertigo is diagnosed by history and physical examination. It is important to confirm the symptom before proceeding to the cause. The key begins with the health care practitioner understanding the patient's complaint and proceeding from there. Questions may be asked in regard to what makes the vertigo worse, what makes the spinning better, and whether there are other associated signs including loss of hearing, tinnitus (ringing in the ear), and nausea and vomiting. Past medical history and medication use may offer clues as to the cause.

Physical examination is helpful in confirming the presence of nystagmus, the abnormal eye motion that the body uses to try to compensate for the abnormal balance signals coming to the brain. A full neurologic exam may be done to make certain that the cause of vertigo is peripheral and due to inner ear issues rather than central problems with the brain. Testing for balance and coordination may help decide if the cerebellum is working properly.

Hearing tests may be appropriate to make certain that the middle ear, the cochlea, and the auditory nerve are functioning properly and it is only the labyrinth that is the cause of vertigo.

The Dix-Hallpike test can be performed by the health care practitioner and help with the diagnosis. By moving the head in different directions, eye movements can be assessed and see whether they correlate with the vertigo symptoms.

If there is concern that there is a central brain problem may be the cause of vertigo, CT or MRI imaging of the brain may be considered. Screening blood tests may also be done.

Specialist consultation with a neurologist or otolaryngologist (ear, nose and throat specialist) may be considered to help with the diagnosis and treatment. Physical therapists specially trained in vestibular rehabilitation may be helpful, not only in making the diagnosis, but also in treating peripheral causes like benign paroxysmal positional vertigo or labyrinthitis.

Medically Reviewed by a Doctor on 1/6/2014

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Vertigo - Cause Question: How was the diagnosis as to the cause of your vertigo (dizziness and vestibular balance disorders)?
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