Vertigo

Vertigo is a symptom defined by the sensation that you or your surroundings are spinning or moving. It is a type of dizziness with a distinct rotational component and is frequently accompanied by imbalance, nausea, vomiting, and nystagmus. Vertigo can result from disorders of the peripheral vestibular apparatus, the central nervous system, or less commonly systemic conditions. Peripheral vertigo often presents with brief, recurrent episodes provoked by head position, while central vertigo may be more constant and associated with neurological signs.

Common causes include benign paroxysmal positional vertigo (BPPV), Ménière’s disease, vestibular neuritis, and labyrinthitis. BPPV arises from displaced otoliths and produces short spinning spells triggered by changes in head position; the Dix-Hallpike maneuver helps confirm it and canalith repositioning maneuvers provide relief. Ménière’s disease features episodic vertigo lasting minutes to hours, with fluctuating hearing loss, tinnitus, and aural fullness. Vestibular neuritis and labyrinthitis present with acute vertigo and nausea; labyrinthitis may involve hearing loss. Central causes include cerebrovascular events (stroke or TIA), migraine-associated vertigo, tumors, and demyelinating diseases, which often show vertical or multidirectional nystagmus and additional neurological symptoms.

Diagnosis relies on history and examination, supported by bedside tests such as head impulse testing and Dix-Hallpike, with imaging (MRI) when central disease is suspected. Management targets the underlying cause and symptom control. BPPV is usually treated with canalith repositioning maneuvers (such as Epley or Semont); vestibular rehabilitation therapy helps in chronic or asymmetric vertigo. Medications may alleviate acute nausea or motion sensitivity; long-term treatment of Ménière’s disease includes dietary changes, diuretics, and intratympanic therapies or rarely surgery. Prognosis varies by cause; BPPV is highly treatable with recurrence possible, while central vertigo requires urgent evaluation for potentially life-threatening conditions.