From the Guidelines
Vertigo, or a sensation of spinning or dizziness, can be caused by various conditions, including benign paroxysmal positional vertigo (BPPV), inner ear infections, Meniere's disease, vestibular migraines, and certain medications, as outlined in the clinical practice guideline on Meniere's disease 1. The causes of vertigo can be categorized into several groups, including:
- Inner ear disorders, such as BPPV, labyrinthitis, and vestibular neuritis
- Neurological conditions, such as stroke, multiple sclerosis, and vestibular migraines
- Infectious diseases, such as Lyme disease and otosyphilis
- Other conditions, such as vestibular schwannoma and autoimmune disorders It is essential to note that vertigo can significantly impact daily life, and proper diagnosis and treatment are crucial to alleviate symptoms and prevent complications. According to the clinical practice guideline on BPPV 1, this condition is the most common inner ear problem and cause of vertigo, characterized by sudden, short spells of vertigo triggered by specific head positions or movements. The guideline also emphasizes the importance of bedside testing, such as the Dix-Hallpike test or supine roll test, to confirm the diagnosis of BPPV 1. Additionally, the guideline provides information on the treatment of BPPV, including repositioning exercises, such as the Epley maneuver, which can be effective in relieving symptoms 1. In summary, the causes of vertigo are diverse, and a thorough evaluation, including a detailed medical history and physical examination, is necessary to determine the underlying cause and provide appropriate treatment, as recommended by the clinical practice guidelines on Meniere's disease and BPPV 1.
From the Research
Causes of Vertigo
- Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Meniere's disease are the most common causes of vertigo 2
- Other causes of vertigo include cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms 2
- Vertigo can be subdivided into two main groups: spontaneous vertigo and provoked vertigo, usually by postural changes, generally called paroxysmal positional vertigo (PPV) 3
- Sudden onset of acute vertigo is usually due to acute spontaneous unilateral vestibular failure, and can also be fluctuant as in recurrent attacks of Ménière's disease 3
Types of Vertigo
- Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, characterized by short-lived episodes of vertigo in association with rapid changes in head position 4, 5
- Posterior canal BPPV is the most frequent form of BPPV 5, 6
- Acute vertigo can be caused by free floating endolymph particles (otoconia displaced from the otolithic membrane of the utricle) in the posterior semicircular canal 4
Diagnosis and Treatment
- The history and physical examination, including special tests such as the Dix-Hallpike maneuver, provide important clues to the diagnosis of vertigo 2
- The Epley maneuver is a effective treatment for posterior canal BPPV, with a high success rate in resolving vertigo symptoms 4, 5
- Brandt-Daroff exercises are also effective in treating BPPV, with similar recovery rates to the Epley maneuver 6