There
are a few tips to get rid of vertigo. Vertigo is a symptom of a
medical condition characterized by the sensation of moving around in space or having objects move around a person ; tends to come in attacks;if severe,accompanied by nausea and vomiting.
Causes of Vertigo
There are a number of different causes of vertigo. Vertigo can be
defined based upon whether the cause is peripheral or central.
Central
causes of vertigo arise in the brain or spinal cord while peripheral
vertigo is due to a problem within the inner ear.
Brain or sensory nerve disturbance:
Central vertigo
is a term that collects together the central nervous system causes - involving a disturbance to one of the following two areas:
Brain or sensory nerve disturbance:
Central vertigo
is a term that collects together the central nervous system causes - involving a disturbance to one of the following two areas:
- The parts of the brain (brainstem and cerebellum) that deal with interaction between the senses of vision and balance, or
- Sensory messages to and from the thalamus part of the brain.
The central nervous system regulate
a sense of balance. Disruption by diseases of the central nervous system such
as multiple sclerosis, tumors, neck damage, or stroke can cause vertigo
Uncommon causes are stroke and transient ischemic attack, cerebellar brain tumor, acoustic neuroma (a non-cancerous growth on the acoustic nerve in the brain) and multiple sclerosis
Peripheral vertigo
is a term that collects together the inner ear causes.
The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity. By telling our brains when there is movement from the vertical position, we are able to keep our balance, maintain equilibrium.
Disturbance to this system therefore produces vertigo and can be created by inflammation among other causes. Viral infection is behind the inflammation seen in the following two conditions:
As well as infection, Meniere's disease can result from metabolic and immune disorders.
recurrent and usuallay progressive vestibular disease;episodic attacks may last from minutes to several hours with severe symptoms ;usually associated with tinnitus ,deafness,sensation of pressure/fullness with in ear;etiology:unknown,edema of membranous labyrinth is a consistent finding
Benign paroxysmal positional vertigo
Benign positional vertigo is due to a disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance.
Benign positional vertigo develops when a small piece of bone-like calcium breaks free and floats within the tube of the inner ear. This sends the brain confusing messages about your body's position.
This is thought to be the cause of most BPPV. Debris is loose within
the fluid filled pathways of the inner ear. When the head is
repositioned with respect to gravity, the particles move to the new
lowest portion of the inner ear.
This causes a "nystagmus", or jumping of the eyes with the following features: Here we are discussing debris in the posterior canal.
In theory, there might be canalithiasis involving any of the semicircular canals (or several at once). Each canal produces a different vector of nystagmus --
Cupulolithiasis
This is thought to be unusual (less than 5%). Here, debris is
attached to the cupula of one of the canals. When the cupula is
horizontal, there is no nystagmus or dizziness. When the cupula is
non-horizontal (most of the time), there is a constant input from the
inner ear and dizziness.
The typical nystagmus of cupulolithiasis is thought to have the following features:
If cupulolithiasis is suspected, it seems logical to treat with either the Epley with vibration, or alternatively, use the Semont maneuver. There are no studies of cupulolithiasis to indicate which strategy is the most effective.
While most cases are spontaneous, BPPV vertigo can also follow:
Uncommon causes are stroke and transient ischemic attack, cerebellar brain tumor, acoustic neuroma (a non-cancerous growth on the acoustic nerve in the brain) and multiple sclerosis
Inner ear disturbance:
unilateral vestibular disorder:[UVD]
is a term that collects together the inner ear causes.
The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity. By telling our brains when there is movement from the vertical position, we are able to keep our balance, maintain equilibrium.
Disturbance to this system therefore produces vertigo and can be created by inflammation among other causes. Viral infection is behind the inflammation seen in the following two conditions:
- Labyrinthitis - this is inflammation of the inner ear labyrinth and vestibular nerve (the nerve responsible for encoding the body's motion and position
- Vestibular neuronitis - this is thought to be due to inflammation of the vestibular nerve. an acute infection with prolonged attack of
symptoms,persisting for several days or weeks;caused by viral or
bacterial infection.
Infections such as colds, flu, or other inflammation can affect the inner ear and cause vertigo.
- Ménière's disease
As well as infection, Meniere's disease can result from metabolic and immune disorders.
recurrent and usuallay progressive vestibular disease;episodic attacks may last from minutes to several hours with severe symptoms ;usually associated with tinnitus ,deafness,sensation of pressure/fullness with in ear;etiology:unknown,edema of membranous labyrinth is a consistent finding
Benign positional vertigo is due to a disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance.
Benign positional vertigo develops when a small piece of bone-like calcium breaks free and floats within the tube of the inner ear. This sends the brain confusing messages about your body's position.
Benign
paroxysmal positional vertigo (BPPV) is the most common disorder of the
inner ear’s vestibular system, which is a vital part of maintaining
balance. BPPV is benign, meaning that it is not life-threatening nor
generally progressive. BPPV produces a sensation of spinning called
vertigo that is both paroxysmal and positional, meaning it occurs
suddenly and with a change in head position. - See more at:
http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo#sthash.ipE9F7RB.dpuf
Benign
paroxysmal positional vertigo (BPPV) is the most common disorder of the
inner ear’s vestibular system, which is a vital part of maintaining
balance. BPPV is benign, meaning that it is not life-threatening nor
generally progressive. BPPV produces a sensation of spinning called
vertigo that is both paroxysmal and positional, meaning it occurs
suddenly and with a change in head position. - See more at:
http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo#sthash.ipE9F7RB.dpuf
Benign
paroxysmal positional vertigo (BPPV) is the most common disorder of the
inner ear’s vestibular system, which is a vital part of maintaining
balance. BPPV is benign, meaning that it is not life-threatening nor
generally progressive. BPPV produces a sensation of spinning called
vertigo that is both paroxysmal and positional, meaning it occurs
suddenly and with a change in head position. - See more at:
http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo#sthash.ipE9F7RB.dpufBenign paroxysmal positional vertigo is twice as common in women than
men, usually affects older people and most often arises without a known
cause (idiopathic).
brief
attacks of vertigo and nystagmus that occur with certain head positions
[lying down,turning over in bed,tilting head back];may be related to
degenerative processes,mechanical impairment of peripheral vestibular
system
Canalithiasis
This causes a "nystagmus", or jumping of the eyes with the following features: Here we are discussing debris in the posterior canal.
- A latency between 5-30 seconds. Particles move out of the ampulla (dilated part of inner ear at bottom of picture above). While they are moving, there is no nystagmus. After the particles finish moving, the nystagmus begins.
- A "burst" of nystagmus, typically lasting 10 seconds.
- The direction of the burst is about the axis of the canal containing the debris (i.e. upbeating and torsional for the posterior canal).
- A reversal of nystagmus on sitting
- Fatigueability (i.e. less nystagmus when the maneuver is repeated, within a short period of time). This is thought to be due to margination.
In theory, there might be canalithiasis involving any of the semicircular canals (or several at once). Each canal produces a different vector of nystagmus --
- Posterior canal -- upbeating and twisting towards earth
- Anterior canal -- downbeating, with variable twisting (torsion)
- Lateral canal - -side-beating, either always downward (geotropic), or always upward (ageotropic).
Cupulolithiasis
The typical nystagmus of cupulolithiasis is thought to have the following features:
- No latency
- Permanent nystagmus, that persists as long as the head is positioned so that the canal being stimulated is not horizontal.
- Posterior canal -- upbeating (excitatory)
- Anterior canal -- upbeating (inhibitory because canal is 180 deg from PC)
- Lateral canal -- small nystagmus that can be either direction.
- Weak nystagmus (about 5 deg/sec), directed about the axis of the canal being stimulated. Cupulolithiasis might occur in any canal -- horizontal, anterior or vertical, each of which might have it's own pattern of positional nystagmus (see above).
- For the lateral canal, the nystagmus is "ageotrophic", meaning that it beats upward with respect to the head position.
- Reversibility when the head is positioned such that canal is flipped 180 degrees. This is called "direction changing", and is most commonly observed in persons in whom lateral canal BPPV is diagnosed.
If cupulolithiasis is suspected, it seems logical to treat with either the Epley with vibration, or alternatively, use the Semont maneuver. There are no studies of cupulolithiasis to indicate which strategy is the most effective.
While most cases are spontaneous, BPPV vertigo can also follow:
- A head injury
- Reduced blood flow in a certain area of the brain (vertebrobasilar ischemia)
- An episode of labyrinthitis
- Ear surgery
- Prolonged bed rest.
Tumour;
acoustic neuroma,gliomas/brainstem,cerebellar medullo blastoma.
- Bilateral vestibular disorders:[BVD]
toxicity;ototoxic drugs
bilateral infection;neuritis,meningitis.
vestibular neropathy,otosclerosis{paget's disease}
- Difficulty seeing
Eye is helps in the functioning of
the body's balance, so that the vision problem, can cause impaired balance and
trigger of vertigo.
blurred vision: gaze instability secondary to vestibulo occular reflex {VOR}dysfunction.
- Migraine
Migraine is actually a type of
headache but often affect vision as well. Vertigo caused by migraine can take
place several minutes to several days.
Not all dizziness is vertigo. Mild
dizziness or spinning feeling may not be due to vertigo. These conditions may
be caused by low blood pressure, hunger, or anxiety.
Examination of ear
Cerebellar function tests
Balance tests – It begins when the patient walks into the room.
Electronystagmography – it records eye movements during various
neck and eye movements. It is the most important investigation
for Vertigo. It helps to differentiate between central and
peripheral vertigo. In peripheral vertigo it helps us to know
which ear is involved. It also involves caloric testing. Here the
recordings are made when the external auditory canal is irrigated
with warm water at 440c and cold water at 300c.
Examination of cranial nerves.
CT Scan and MRI of skull and Brain.
Risk Factors:
Thyroid disease, Hypertension, Diabetes mellitus,
anaemia, decreased supply of blood to brain from posture
related low blood pressure (postural hypotension) or cardiac arrhythmias can lead to dizziness or vertigo.
related low blood pressure (postural hypotension) or cardiac arrhythmias can lead to dizziness or vertigo.
A myriad of medications including those used to
treat high blood pressure, high blood sugar and cardiac arrhythmias
can also predispose a person to vertigo. Even psychogenic disorders
like anxiety disorders, panic syndromes can lead to vertigo.
Diagnosis:
Assesment from specialized doctor or physical therapist may helpfull for the proper diagnosis..
Assesment of anterior and posterior canal bppv:
Assesment of horizontal canal bppv:
Dix hallpike testing;
Assesment from specialized doctor or physical therapist may helpfull for the proper diagnosis..
Assesment of horizontal canal bppv:
Dix hallpike testing;
Examination of ear Cerebellar function tests Balance tests – It begins when the patient walks into the room.
Electronystagmography – it records eye movements during various
neck and eye movements. It is the most important investigation
for Vertigo. It helps to differentiate between central and
peripheral vertigo. In peripheral vertigo it helps us to know
which ear is involved. It also involves caloric testing. Here the
recordings are made when the external auditory canal is irrigated
with warm water at 440c and cold water at 300c. Examination of cranial nerves. CT Scan and MRI of skull and Brain.
please refer my next blog....Tips to get rid of vertigo
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