Neurology Now:
doi: 10.1097/01.NNN.0000299022.09781.fb
Department: the Waiting Room: This Way in

Spin Doctors

Smolinsky, Mike

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If you've never experienced vertigo, check out Alfred Hitchcock's film noir classic by the same name: the sensational rooftop opener will make your head swim. Hitchcock knew the feeling of dizziness is as unsettling as it is common, which is why audiences have loved Vertigo since its release in 1958.

Actually, dizziness and vertigo are different. “Dizziness is a general term for spatial disorientation, while vertigo is an illusion of motion—usually spinning,” explains Robert W. Baloh, M.D., professor of neurology and head and neck surgery at UCLA School of Medicine.

Vertigo can make your life miserable, and the majority of cases go untreated, says Dr. Baloh. An article in the journal Neurology in 2005 concluded that vertigo affects at least five percent of adults. According to the National Institutes of Health, a majority of people 70 years of age and older report dizziness and balance problems, and balance-related falls account for more than one-half of accidental deaths in the elderly. In one study of 65- to 75-year-olds, one-third reported that dizziness and imbalance have a negative impact on quality of life.

“The most common causes of vertigo are inner-ear problems: benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's syndrome,” Dr. Baloh says. “But it is also a common symptom with migraine and occurs in at least 50 percent of patients with multiple sclerosis.”

BPPV (the most common cause of vertigo) involves intense, brief episodes of vertigo associated with a change in the position of your head, such as when sitting up in bed. “Most physicians—including some neurologists—prescribe meclizine (Antivert) for vertigo, regardless of the cause,” Dr. Baloh says. “At best it provides symptomatic relief, particularly for associated nausea, but it does not address the underlying problem”—the breaking loose of normal calcium carbonate crystals in your ear. These crystals can fall into the wrong part of your inner ear canal and stimulate sensors, causing vertigo. Doctors don't know what causes BPPV, though it may be due to aging or head trauma. Thankfully, “there is a simple cure for BPPV,” Dr. Baloh says: canalith repositioning, in which the doctor maneuvers your head so that the particles shift and can be reabsorbed into your body's fluids.

Vestibular neuritis, which may be caused by a virus, is an inflammation in the inner ear that causes sudden, intense vertigo along with nausea and vomiting. The episodes can last for days and sometimes require bed rest. Vestibular neuritis usually clears up on its own, although balance-retraining exercises—which you learn from a physical therapist—can speed recovery.

Meniere's disease produces excessive fluid buildup in your inner ear that causes sudden episodes of vertigo lasting 30 minutes or longer. Other symptoms include a feeling of fullness in the ear, buzzing or ringing in the ear (tinnitus), and fluctuating hearing loss. The cause of Meniere's disease is unknown. Treatment usually involves reducing your body's retention of fluids through diuretics or a low-salt diet.

To manage vertigo:

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▸ Be aware of the possibility of losing your balance, which can lead to injury.

▸ Sit or lie down immediately when you feel dizzy.

▸ Avoid driving a car if you experience frequent dizziness.

▸ Use good lighting if you get out of bed at night.

▸ Walk with a cane for stability.

▸ Avoid using caffeine, alcohol, and tobacco, all of which restrict your blood vessels and worsen symptoms.

▸ Learn the physical techniques. “We teach patients to perform the particle-repositioning maneuver for recurrent BPPV,” Dr. Baloh says. “And vestibular exercises are helpful if there is damage to the inner ear, such as occurs with vestibular neuritis.”

In rare cases, vertigo can be a sign of a more serious neurological problem. “Vertigo can be the initial symptom of stroke,” Dr. Baloh says, so he advises people to talk to their doctor “if they are older and have vascular risk factors, such as a prior stroke, hypertension, or diabetes.” You should also see your doctor if your vertigo is accompanied by:

▸ A new, different, or severe headache

▸ Blurred or double vision

▸ Slurred speech

▸ Hearing loss

▸ Leg or arm weakness

▸ Loss of consciousness

▸ Falling or difficulty walking

▸ Numbness or tingling

▸ Chest pain or rapid or slow heart rate

Don't ignore vertigo or try to live with it. Let your neurologist help get you back on an even keel.

Mike Smolinsky

©2007 American Academy of Neurology

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