Dizziness and Vertigo

Dizziness/Vertigo: Definitions & Types - Dizzying Distinctions

• Dizziness: Vague sensation; e.g., lightheadedness, wooziness.
• Vertigo: Illusion of movement (self or surroundings); often rotational/spinning.
  • Peripheral: Inner ear/vestibular nerve (CN VIII) origin. Typically intense, with nausea/vomiting, auditory symptoms (tinnitus, hearing loss). Nystagmus: usually unidirectional, horizontal, fatigable, suppressed by visual fixation.
  • Central: Brainstem/cerebellar origin. Vertigo often less intense; associated neurological deficits (e.g., diplopia, dysarthria, ataxia) common. Nystagmus: can be multidirectional (e.g., vertical), non-fatigable, not suppressed by fixation.
• Presyncope: Feeling of impending faint or loss of consciousness.
• Disequilibrium: Sense of imbalance or unsteadiness, primarily when standing or walking.

⭐ Vertigo accompanied by new neurological deficits (e.g., diplopia, dysarthria, limb ataxia, facial droop) or inability to stand/walk unaided strongly suggests a central cause, such as a posterior circulation stroke, requiring urgent evaluation (HINTS exam may be useful).

Peripheral Vertigo: Causes & Features - Ear's Inner Turmoil

• Benign Paroxysmal Positional Vertigo (BPPV)
  • Cause: Otoconia (canaliths) in semicircular canals (posterior most common).
  • Features: Brief vertigo episodes (seconds to <1 min), triggered by head movements. No auditory symptoms.
  • Dx: Positive Dix-Hallpike maneuver. Tx: Epley maneuver.
• Meniere's Disease
  • Cause: Endolymphatic hydrops (↑ endolymph).
  • Classic Triad:
    • Episodic vertigo (20 mins to hours).
    • Fluctuating sensorineural hearing loss (SNHL), initially low-frequency.
    • Tinnitus (roaring) & aural fullness.
  • 📌 Vertigo, Hearing loss, Tinnitus, Sensation of fullness (Meniere's Triad).
• Vestibular Neuritis
  • Cause: Vestibular nerve (CN VIII) inflammation, often post-viral.
  • Features: Sudden, severe, persistent vertigo (days). Nausea, vomiting. NO hearing loss/tinnitus.
  • Dx: Abnormal head impulse test.
• Labyrinthitis
  • Cause: Labyrinth inflammation (vestibular nerve + cochlea).
  • Features: Similar to vestibular neuritis PLUS unilateral SNHL and/or tinnitus.

⭐ BPPV is the most common cause of recurrent vertigo; Dix-Hallpike test for posterior canal BPPV elicits torsional upbeating nystagmus towards the affected ear.

Central Vertigo: Causes & Red Flags - Brain's Balancing Blips

Error generating content for this concept group: Failed to process successful response

Dizziness/Vertigo: Diagnostic Approach & Management - Finding Firm Footing

• Approach: History (timing, triggers, associated symptoms) & focused exam.
• Key Examinations:
  • HINTS (Head Impulse, Nystagmus, Test of Skew) → Central vs. Peripheral.
  • Dix-Hallpike → BPPV.
  • Full neuro exam.
• Investigations: Audiometry; MRI if central suspected/red flags.
• Management Principles:
  • BPPV: Epley maneuver.
  • Vestibular Neuritis/Labyrinthitis: Steroids, vestibular suppressants (short-term).
  • Meniere's: Lifestyle (↓salt), diuretics.
  • Central: Address underlying cause.
  • Vestibular Rehabilitation Therapy (VRT).

⭐ In acute vestibular syndrome, a HINTS exam suggesting central vertigo (e.g., direction-changing nystagmus, abnormal Test of Skew) is more sensitive than early (<48h) MRI for detecting stroke.

High‑Yield Points - ⚡ Biggest Takeaways

• Peripheral vertigo: intense, nausea/vomiting, unidirectional nystagmus (suppressed by fixation).
• Central vertigo: neurological deficits, multidirectional/vertical nystagmus (not suppressed by fixation).
• BPPV: most common, positional, Dix-Hallpike (Dx), Epley maneuver (Tx).
• Meniere's disease: triad of episodic vertigo, sensorineural hearing loss, tinnitus.
• Vestibular neuritis: sudden severe vertigo (post-viral); labyrinthitis adds hearing loss.
• HINTS exam: differentiates stroke from peripheral causes in acute continuous vertigo.
• Distinguish vertigo from presyncope (lightheadedness) and disequilibrium (imbalance).