Vertigo is not a disease but a symptom that can occur in different pathologies. The word vertigo comes from the Latin vertere which means to spin or rotate. Vertigo is defined as a distortion and disorientation of the movement of the body in space. To understand what causes vertigo we must understand the whole mechanism involved in maintaining balance.
Mechanism of balance
There are several systems that participate in the orientation of our body: the visual, the vestibular (the inner ear), and the proprioceptive (these receptors are located in the muscles, tendons, joints, and skin). Vertigo occurs when there is an anomaly in one of these systems and it can also result from a problem in the brain, responsible for the analysis and integration of information on the movement and position of the head and body. This condition can affect any age and is usually accompanied by other symptoms, such as nausea, vomiting, headaches, pallor, increased heart rate, and loss of consciousness.
Vertigo corresponds to an illusion of movement, with a feeling of displacement of the surrounding objects in relation to the individual or vice versa. Most often the environment seems to be rotating around the patient, but it can also manifest as a sliding sensation to one side or up and down.
Vertigo and Dizziness
It is necessary to distinguish vertigo from dizziness. Dizziness is a generic designation that encompasses all situations where a disturbance occurs in the individual’s relationship with space, and vertigo should be considered a particular form of dizziness. This distinction is not always easy, especially in cases of great anxiety or when dizziness occurs in the context of a psychiatric illness.
Typically, vertigo results from a lesion in the inner ear, in its peripheral receptors, in the pathways that lead to the information collected or in the centers of the central nervous system that process that information.
Disorders of vision or disorders of a special type of sensitivity (proprioceptive) tissue existing in skin, bones, muscles, and joints of the whole body can also result in dizziness, whose distinction from vertigo can be very difficult.
Vertigo is part of a wider set of disorders, called vestibular disorders, which are very common. For example, in the United States, it is estimated that about 35% of the population over the age of 40 has had at least one episode of vestibular disturbance.
What causes vertigo?
There are numerous causes of vertigo. The body detects posture and controls balance through balance organs located in the inner ear. These have nerve connections to specific areas of the brain that allow you to maintain balance. Hence, vertigo can be caused by disorders of the ear, the nerves that connect the ear to the brain, or the brain itself. In more aggressive acute or chronic ear infections, toxic substances can spread to the inner ear and interfere with its proper functioning to the balance.
Vertigo may also be related to bacterial or viral infections, visual problems, sudden changes in blood pressure (in the form of orthostatic hypotension), but also with labyrinthitis, neuritis, traumatic brain injury, tumors of the auditory or brain nerve, strokes, meningitis, ototoxicity from certain drugs, barotraumatism due to pressure variation, among others.
Ménière’s disease causes episodic and sudden attacks of vertigo, together with ringing in the ears (tinnitus) and progressive hearing loss or deafness.
In relation to the brain, vertigo may occur in the context of migraines, after a stroke, following transient episodes of ischemia, or in multiple sclerosis.
Diagnosis
The diagnosis involves clinical history and a medical examination of the auditory and nervous system. Some tests allow you to provoke an episode of vertigo and, thus, help to understand what its cause is. Tests such as audiometry, impedanciometry, evoked potentials, posturography, and imaging tests (computed tomography or magnetic resonance imaging) are frequently used to diagnose vertigo.
Treatment
Some cases of vertigo do not require treatment since they often disappear spontaneously. In others instances, there are certain maneuvers that can be performed that allow you to control and treat vertigo such as the Epley maneuver for benign paroxysmal positional vertigo (BPPV). Depending on its cause, there are other treatment possibilities, such as anti-inflammatory or antiemetic drugs (if there is significant vomiting), among others.
Anyone can experience vertigo, and there really is no true preventive step to prohibit an initial episode of vertigo from arising. Since vertigo causes a powerful feeling of imbalance, it is important to avoid situations in which falls may occur, especially for the elderly prone to suffer from falls.
Reference
Lydia Krause, Dana Robinson, Meredith Goodwin, MD, FAAFP, Vertigo and Vertigo-Associated Disorders, 2020.
Retrieved from; https://www.healthline.com/health/vertigo
Julie Marks, Sanjai Sinha, MD, What Is Vertigo? Symptoms, Causes, Diagnosis, Treatment, and Prevention, 2020.
Retrieved from; https://www.everydayhealth.com/vertigo-signs-symptoms-latest-treatments-home-remedies-tests-more/
