VERTIGO
What is
vertigo?
Vertigo is a common
symptom in patients presenting to neurology outpatient department. It is
described as a sense of rotation (rotation of self or of the surroundings).
Other terms to describe the same sensation are dizziness, giddiness, chakkar
(in Hindi), tala tiragadam (in Telugu), etc.
What are the
common symptoms in a patient with vertigo?
The most common feeling
is a sense of rotation or imbalance. This feeling becomes more prominent while
walking or moving. In some cases, even head or neck movements (such as getting
up from lying down position or bending down to pick something) can aggravate
the symptoms of dizziness. Other symptoms may include:
·
Nausea,
·
Vomiting,
·
Imbalance
while walking,
·
Blurred
vision,
·
Poor
concentration.
What are the
common causes of vertigo?
Vertigo can be caused by
a variety of reasons. The more important of them include:
BPPV- benign
paroxysmal positional vertigo
·
In this
condition, there is a problem in the inner ear. Calcium crystals get deposited
in one of the semicircular canals.
·
It can occur
in all ages, and is common in adults and in older people. It affects 2.4% of
population sometime in their lifetime.
·
It is a benign
condition, which means it is not life-threatening and it does not get worse
over time,
·
Symptoms are
made worse with head or neck movements (positional symptoms),
·
Symptoms
occur intermittently,
·
People may
get better in 1-2 days, however, in some, it may last for a few months also,
·
Head injury,
concussion, migraine, etc may bring on the symptoms of BPPV
·
Diagnosis is
made on the basis of history and clinical examination. Hearing and vestibular
tests may be helpful.
·
Treatment
consists of symptomatic treatment with antihistaminic medications such as betahistine
tablets.
·
Canal
repositioning procedures done in office are helpful and can cure the condition, however, these procedures should be done by trained doctors,
·
Vestibular
adaptation exercises help in prevention of recurrent episodes of vertigo.
·
In
refractory cases, there may be a role for ear surgery.
2
Posterior
circulation stroke (Brain stroke)
·
This refers
to reduction in blood supply to the back of brain, mainly cerebellum and brain
stem.
·
This is more
common in people with risk factors for stroke, such as high blood pressure,
diabetes, high cholesterol, smoking, etc.
·
Patients
often have additional symptoms such as double vision, slurred speech,
difficulty in swallowing, imbalance while walking, etc. Isolated symptoms of
vertigo without any additional symptoms, seldom/rarely occur due to brain stroke.
·
The
diagnosis can be confirmed by doing an MRI scan of brain.
·
Treatment is
done as for brain stroke (refer to my earlier blog articles on brain stroke
management).
Cervical
vertigo
·
This is an
uncommon cause of vertigo,
·
Occurs in
the setting of severe cervical spondylosis and disc disease in the cervical
(neck) region,
·
Cervical vertigo is also more
common in older people.
·
Treatment is
as for disc disease (refer to my earlier article on disc disease)
In addition to the above listed main causes of vertigo, we should also look for other causes. These include low blood pressure, anemia (low haemoglobin), general weakness, low blood sugars, etc.
Who should we consult for vertigo?
Initially, a primary
care physician may be consulted. If there is a doubt in exact diagnosis, the
patient should be evaluated by a neurologist.
An ENT opinion may be
taken if an ear-related cause is suspected.
What is the outcome in cases of vertigo?
Most people with vertigo
recover well and they do so in a few days. However, a minority of patients
continue to suffer for several months. It is uncommon for the symptoms to last
for more than three months.
Vertigo may be disabling
in the first few days of illness, however, after that period, most people are
able to normally function.
Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Email: drsudhirkumar@yahoo.com
Phone (for appointment): 0091-40-23607777, extension 6634/3011
Online consultation: http://bit.ly/Dr-Sudhir-kumar
