Vertigo: Causes, Symptoms and Diagnosis

Vertigo is the feeling of a sense that you or your environment is spinning. You have a sensation of feeling off balance.

Updated: June 16, 2022

Vertigo is the feeling of a sense that you or your environment is spinning. You have a sensation of feeling off-balance.

Causes of Vertigo:

Vertigo can be peripheral or central. Vertigo if arise in the brain or spinal cord called Central while peripheral vertigo is due to a problem within the inner ear.

Some of the most common causes are:

Benign Paroxysmal Positional Vertigo (BPPV):

The inner ear helps you keep your balance by sending signals to the brain about head and body movements relative to gravity. BPPV occurs when tiny calcium particles clump up in canals of the inner ear causing inflammation. BPPV can occur because of the age factor.

Meniere's disease:

Meniere's disease can be caused by fluid accumulation in the inner ear and changing pressure in the ear. This may lead to vertigo along with ringing in the ears called tinnitus and hearing loss.

Vestibular neuritis or labyrinthitis:

This is due to due to a viral or bacterial inner ear infection. The infection causes inflammation in the inner ear around nerves those help the body to sense balance.
Vertigo may be associated with some other rare causes such as:

  • Migraine headaches
  • Brain problems such as stroke or tumor
  • Head trauma or neck injury
  • Certain medications that cause ear damage
  • Decreased blood flow to the base of the brain
  • Complications from diabetes
  • Multiple sclerosis

Symptoms of Vertigo:

The symptoms of vertigo should not be confused with symptoms of lightheadedness or fainting. Symptoms of vertigo include :

  • a sensation of disorientation or motion
  • nausea or vomiting
  • abnormal eye movements
  • sweating
  • rotational dizziness
  • hearing loss and a ringing sensation in the ears
  • visual disturbances
  • weakness
  • difficulty speaking
  • a decreased level of consciousness
  • difficulty walking

The duration of symptoms can be last from minutes to hours.

Diagnosis of Vertigo:

The Doctor may obtain a full history of the events and symptoms during an evaluation for vertigo. This includes how the dizziness makes you feel, any medications that have been taken, recent illnesses, and any prior medical problems such as any history of migraine or a recent head injury or ear infection. A physical examination is performed after the history is obtained. This includes a full neurological exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause.

Some cases of vertigo may require an MRI or CT scan of the brain or inner ears.

Nystagmus Test:

Nystagmus is an uncontrolled eye movement, that happens from side to side. When you have vertigo, eye movement happens when you try to fix your eyes on one position while looking at something that is passing quickly. The doctor may perform the following exercise to check for nystagmus:

The doctor quickly moves the patient from a sitting position to lying down on the examination bench and his/her head is turned and held 45 degrees toward the affected side and moved 30 degrees down at the end of it before this quick movement,  over the end of the bench, below the horizontal position of the rest of the body. If the doctor observes specific eye movements or nystagmus and you experience vertigo, you are diagnosed to have vertigo.

Electronystagmography (ENG) :

In this test, you wear a headset that places electrodes around the eyes. The device measures eye movements and electronically record the nystagmus.

Videonystagmography (VNG):

A video recording of the nystagmus can be done in this test. You have to wear a pair of special glasses that contain video cameras that record horizontal, vertical, and torsional eye movements using infrared light. The data collected can be analyzed by computer processing.

The head impulse test:

You are asked to fix your gaze on the tip of the doctor's nose while the head is moved quickly to one side. If you can not keep your eyes on the nose during this movement, vertigo is diagnosed.

Romberg's test:

If you become unsteady when you shut your eyes in standing position, this is a sign of vertigo. The side you fall toward is normally the side where the ear is affected.

Unterberger's test:

You are told to marches on the spot for 30 seconds with your eyes closed. If vertigo is present, there may be sideways rotation, toward the affected side.

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