vertig/chakkar

 Vertigo

✅ Definition

Vertigo is a sensation of spinning or movement when the patient or surroundings are actually still. It is a symptom, not a disease.

Causes of Vertigo

1. Peripheral (Ear-related) – most common

Benign Paroxysmal Positional Vertigo (BPPV) – due to displaced otoliths in the inner ear

Ménière’s disease – excess fluid in inner ear

Vestibular neuritis / Labyrinthitis – viral or bacterial infection

Ototoxic drugs – e.g., aminoglycosides, furosemide

Trauma – head injury, barotrauma

2. Central (Brain-related)

Stroke (vertebrobasilar ischemia)

Multiple sclerosis

Cerebellar tumor or migraine

Diagnosis of Vertigo

1. History & Clinical Examination

Onset: sudden (BPPV, stroke) vs gradual

Duration: seconds (BPPV), hours (Ménière’s), days (neuritis)

Associated symptoms: hearing loss, tinnitus, nausea, imbalance, neurological signs

2. Bedside Tests

Dix–Hallpike test → confirms BPPV

Head thrust test → vestibular neuritis

Romberg test / Unterberger test → balance evaluation

3. Investigations (if central cause suspected)

Audiometry (hearing test)

MRI Brain / CT Scan

Blood tests (if metabolic or drug cause suspected)

Treatment of Vertigo

1. General Measures

Reassurance, avoid sudden head movements

Adequate hydration & rest

2. Specific Treatment

BPPV → Epley’s repositioning maneuver

Ménière’s disease → salt restriction, diuretics (e.g., acetazolamide), betahistine

Vestibular neuritis / Labyrinthitis → corticosteroids (sometimes), antibiotics if bacterial

Central causes → treat underlying stroke, tumor, migraine

3. Symptomatic Relief

Vestibular suppressants (short-term only):

Betahistine

Cinnarizine / Flunarizine

Meclizine / Dimenhydrinate

Diazepam (if severe)

Anti-emetics → ondansetron, domperidone

4. Rehabilitation

Vestibular rehabilitation exercises – Brandt-Daroff exercises, balance training

📌 Key Point for Patient Communication:

Most vertigo cases are benign and treatable. Proper diagnosis is essential to differentiate between ear-related (common & harmless) and brain-related (serious but less common) causes.