What is Vertigo?
Vertigo is an illusory sensation of motion of either yourself or your surroundings in the absence of true motion, typically described as a spinning or rotational sensation. 1
Core Definition and Characteristics
Vertigo represents a specific type of dizziness that must be distinguished from other forms of dizziness such as disequilibrium, lightheadedness, or presyncope. 1 The American Academy of Otolaryngology-Head and Neck Surgery formally defines vertigo as an illusory sensation of motion when no actual motion is occurring. 1
Key Distinguishing Features
- Rotational quality: Patients typically describe a spinning sensation, though some may describe it as a sensation of tilt or false movement. 2
- Absence of true motion: The sensation occurs without any actual movement of the patient or environment. 1, 3
- Distinct from general "dizziness": While dizziness is a non-specific term that may imply disequilibrium, light-headedness, or presyncope, vertigo specifically refers to the illusion of motion. 1
Anatomical Basis
Vertigo indicates dysfunction of either the vestibular system (peripheral) or central vestibular pathways. 1
Peripheral Vertigo
- Originates from the inner ear structures: The vestibule and semicircular canals serve as the end organs responsible for balance and equilibrium. 1
- Most common cause: Benign paroxysmal positional vertigo (BPPV) accounts for 17-42% of all vertigo cases. 1
Central Vertigo
- Results from CNS lesions: Central vestibular pathways involve extensive connections between the vestibular nuclei within the brainstem and the cerebellum, extraocular nuclei, and spinal cord. 1
- Often accompanied by neurological deficits: Central vertigo frequently presents with focal neurological signs such as dysarthria, dysmetria, dysphagia, or sensory/motor loss. 4, 5
Associated Symptoms
Vertigo is commonly accompanied by autonomic symptoms that can significantly impact patient quality of life. 3
- Nausea and vomiting: Visceral autonomic symptoms are frequent accompaniments. 1, 3
- Spatial disorientation: Severe sense of disorientation in space during episodes. 4
- Visual disturbances: May include visual blurring, oscillopsia (illusion of visual motion), and difficulty with visual focus. 6
- Imbalance and instability: Particularly concerning in older adults due to increased fall risk. 4
Clinical Significance
Vertigo accounts for 5.6 million clinic visits annually in the United States, representing 2-3% of emergency department consultations worldwide. 1, 7 The distinction between peripheral and central vertigo is critical for appropriate management and can usually be made clinically through careful history and examination, including analysis of nystagmus patterns and specialized tests like the head impulse test. 1, 7