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Vertigo (medical)

 

 
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Vertigo (from the Latin
Latin

Latin is an Italic language, historically spoken in Latium and Ancient Rome. Through the Military history of the Roman Empire, Latin spread throughout the Mediterranean and a large part of Europe....
 vertigin-, vertigo, "dizziness," originally "a whirling or spinning movement," from vertere "to turn") is a specific type of dizziness
Dizziness

Dizziness describes a number of subjective symptoms, which the patient may describe as feelings of lightheadedness, floating, wooziness, giddiness, confusion, disorientation or loss of balance....
, a major symptom of a balance disorder
Balance disorder

A balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning, or floating....
. It is the sensation of spinning or swaying while the body is actually stationary with respect to the surroundings.

The effects of vertigo may be slight. It can cause nausea
Nausea

Nausea is the sensation of unease and discomfort in the stomach with an urge to vomit....
 and vomiting
Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure....
 and, in severe cases, it may give rise to difficulties with standing and walking.

igo-like symptoms may also appear as paraneoplastic syndrome
Paraneoplastic syndrome

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells....
 (PNS) in the form of opsoclonus myoclonus syndrome
Opsoclonus myoclonus syndrome

Opsoclonus myoclonus syndrome is a rare neurological disease of unknown causes which appears to be the result of an autoimmune process involving the nervous system....
, a multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses.

Vertigo can be caused by inflammation of the inner ear due to the common cold, influenza, and bacterial infections.

Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway.






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Vertigo (from the Latin
Latin

Latin is an Italic language, historically spoken in Latium and Ancient Rome. Through the Military history of the Roman Empire, Latin spread throughout the Mediterranean and a large part of Europe....
 vertigin-, vertigo, "dizziness," originally "a whirling or spinning movement," from vertere "to turn") is a specific type of dizziness
Dizziness

Dizziness describes a number of subjective symptoms, which the patient may describe as feelings of lightheadedness, floating, wooziness, giddiness, confusion, disorientation or loss of balance....
, a major symptom of a balance disorder
Balance disorder

A balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning, or floating....
. It is the sensation of spinning or swaying while the body is actually stationary with respect to the surroundings.

The effects of vertigo may be slight. It can cause nausea
Nausea

Nausea is the sensation of unease and discomfort in the stomach with an urge to vomit....
 and vomiting
Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure....
 and, in severe cases, it may give rise to difficulties with standing and walking.

Causes


Vertigo is usually associated with a problem in the inner ear
Inner ear

The inner ear is the labyrinth , a system of passages comprising two main functional parts:* the organ of hearing, or cochlea* and the vestibular apparatus, the organ of balance that consists of three semicircular canals and the Vestibule of the ear....
 balance mechanisms (vestibular system
Vestibular system

The vestibular system, which contributes to our balance and our sense of spatial orientation, is the sensory system that provides the dominant input about movement and equilibrioception....
), in the syndrome and Meniere's disease
Ménière's disease

M?ni?re's disease is a disorder of the inner ear that can affect Hearing and balance. It is characterized by episodes of dizziness and tinnitus and progressive hearing loss, usually in one ear....
. Vertigo-like symptoms may also appear as paraneoplastic syndrome
Paraneoplastic syndrome

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells....
 (PNS) in the form of opsoclonus myoclonus syndrome
Opsoclonus myoclonus syndrome

Opsoclonus myoclonus syndrome is a rare neurological disease of unknown causes which appears to be the result of an autoimmune process involving the nervous system....
, a multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses.

Vertigo can be caused by inflammation of the inner ear due to the common cold, influenza, and bacterial infections.

Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings.

Vertigo can also occur after long flights or boat journeys where the mind gets used to turbulence, resulting in a person's feeling as if he is moving up and down. This usually subsides after a few days.

Another source of vertigo is through exposure to high levels of sound pressure, rattling the inner ear and causing a loss of balance.

Consumption of alcohol can also cause vertigo.

Neurochemistry

The neurochemistry of vertigo includes 6 primary neurotransmitter
Neurotransmitter

Neurotransmitters are chemistry which relay, amplify and modulate signals between a neuron and another cell . Neurotransmitters are packaged into vesicles that cluster beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they bind to receptors in the membrane on the postsynaptic side of...
s that have been identified between the 3-neuron arc that drives the vestibulo-ocular reflex
Vestibulo-ocular reflex

The vestibulo-ocular reflex or oculovestibular reflex is a reflex eye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field....
 (VOR). Many others play more minor roles.

Three neurotransmitters that work peripherally and centrally include glutamate, acetylcholine
Acetylcholine

The chemical compound acetylcholine is a neurotransmitter in both the peripheral nervous system and central nervous system in many organisms including homo sapiens....
, and GABA
Gabâ

Gab? or gabaa, for the Cebuano people , is the concept of a non-human and non-divine, imminent Retributive justice. A sort of negative karma, it is generally seen as an evil effect on a person because of their wrongdoings or transgressions....
.

Glutamate maintains the resting discharge of the central vestibular neurons, and may modulate synaptic transmission
Chemical synapse

Chemical synapses are specialized junctions through which neurons signal to each other and to non-neuronal cells such as those in neuromuscular junctions or glands....
 in all 3 neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. GABA is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells and the lateral vestibular nucleus, and the vertical VOR.

Three other neurotransmitters work centrally. Dopamine
Dopamine

Dopamine is a neurotransmitter occurring in a wide variety of animals, including both vertebrates and invertebrates. In the human brain, this phenethylamine functions as a neurotransmitter, activating the five types of dopamine receptors ? D1, D2, D3, D4 and D5, and their variants....
 may accelerate vestibular compensation. Norepinephrine
Norepinephrine

Norepinephrine or noradrenaline is a catecholamine with dual roles as a hormone and a neurotransmitter.As a stress hormone, norepinephrine affects parts of the brain where attention and responding actions are controlled....
 modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine
Histamine

Histamine is a biogenic amine involved in local immune system as well as regulating physiological function in the gut and acting as a neurotransmitter....
 is present only centrally, but its role is unclear. It is known that centrally acting antihistamines modulate the symptoms of motion sickness.

The neurochemistry of emesis overlaps with the neurochemistry of motion sickness and vertigo. Acetylcholine, histamine, and dopamine are excitatory neurotransmitters, working centrally on the control of emesis. GABA inhibits central emesis reflexes. Serotonin
Serotonin

Serotonin is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system and enterochromaffin cells in the gastrointestinal tract of animals including humans....
 is involved in central and peripheral control of emesis but has little influence on vertigo and motion sickness
Motion sickness

Motion sickness or kinetosis is a condition in which a disagreement exists between visually perceived movement and the vestibular system's sense of movement....
.

Diagnostic testing

Tests of vestibular system
Vestibular system

The vestibular system, which contributes to our balance and our sense of spatial orientation, is the sensory system that provides the dominant input about movement and equilibrioception....
 (balance) function include electronystagmography
Electronystagmography

Electronystagmography is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo , dizziness or balance disorder dysfunction by testing the vestibular system....
 (ENG), rotation tests, Caloric reflex test
Caloric reflex test

In medicine, the caloric reflex test is a test of the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the external auditory canal....
, and Computerized Dynamic Posturography
Posturography

Posturography is a general term that covers all the techniques used to quantify postural control in upright stance in either static or dynamic conditions....
 (CDP).

Tests of auditory system
Auditory system

The auditory system is the sensory system for the sense of hearing ....
 (hearing) function include pure-tone audiometry, speech audiometry, acoustic-reflex, electrocochleography (ECoG), otoacoustic emissions (OAE), and auditory brainstem response test
Auditory Brainstem Response

Auditory brainstem response is an electrical signal evoked from the brainstem of a human or other mammal by the presentation of a sound such as a click....
 (ABR; also known as BER, BSER, or BAER).

Other diagnostic tests include magnetic resonance imaging
Magnetic resonance imaging

GaneshMagnetic resonance imaging , or nuclear magnetic resonance imaging , is primarily a medical imaging technique most commonly used in radiology to visualize the structure and function of the body....
 (MRI) and computerized axial tomography (CAT or CT).

Treatment

Treatment is specific for underlying disorder of vertigo:

  • vestibular rehabilitation
  • anticholinergics
  • antihistamines
  • benzodiazepines
  • calcium channel antagonists
    Calcium channel blocker

    Calcium channel blockers are a class of medication and natural substances which disrupt the conduction of calcium channels.It has effects on many excitable cells of the body, such as cardiac muscle, i.e....
    , specifically Verapamil
    Verapamil

    Verapamil is an L-type calcium channel blocker of the phenylalkylamine class. It has been used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, and most recently, cluster headaches....
     and Nimodipine
    Nimodipine

    Nimodipine is a dihydropyridine calcium channel blocker originally developed for the treatment of arterial hypertension. It is not frequently used for this indication, but has shown good results in preventing a major complication of subarachnoid hemorrhage termed vasospasm; this is now the main use of nimodipine....
  • GABA
    Gabâ

    Gab? or gabaa, for the Cebuano people , is the concept of a non-human and non-divine, imminent Retributive justice. A sort of negative karma, it is generally seen as an evil effect on a person because of their wrongdoings or transgressions....
     modulators, specifically gabapentin
    Gabapentin

    Gabapentin is a Gamma-aminobutyric_acid analogue. It was originally developed for the treatment of epilepsy, and currently, gabapentin is widely used to relieve pain, especially neuropathic pain....
     and baclofen
    Baclofen

    Baclofen is a derivative of gamma-aminobutyric acid primarily used to treat spasticity.It is an agonist specific to mammalian but not fruit fly GABA B receptors....
  • neurotransmitter reuptake inhibitors such as SSRI's, SNRI's
    Serotonin-norepinephrine reuptake inhibitor

    Serotonin-norepinephrine reuptake inhibitors are a class of antidepressant used in the treatment of major depressive disorder and other mood disorders....
     and tricyclics
  • benign paroxysmal positional vertigo
    Benign paroxysmal positional vertigo

    Benign paroxysmal positional vertigo or benign paroxysmal vertigo is a disorder caused by problems in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in head position....
     (BPPV), a special kind of vertigo, is treated with the Epley maneuver
    Epley maneuver

    The Epley maneuver is a maneuver used to treat benign paroxysmal positional vertigo . It is often performed by a doctor but can be performed by the patient at home....
     (performed by a doctor or physical therapist, or with a BPPV maneuver at home
    DizzyFIX

    The DizzyFIX is an FDA cleared home medical device available to assist in the treatment of Benign Paroxysmal Positional Vertigo and its associated vertigo....
    )
  • antibiotics if the underlying cause is inflammation of the inner ear due to bacterial infection.


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