Vertigo and Dizziness

Vertigo and dizziness are common symptoms encountered in clinical practice, often requiring careful evaluation to determine their underlying causes. 

1. Definitions:

   • Vertigo: A specific type of dizziness characterized by the sensation that you or your surroundings are spinning or moving. It is often associated with vestibular disorders.
   • Dizziness: A broader term that encompasses various sensations, including lightheadedness, unsteadiness, or a feeling of faintness.

2. Common Causes:

   • Peripheral Causes: These include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease. These conditions affect the inner ear and are often associated with vertigo.
   • Central Causes: These involve the central nervous system and can include conditions like stroke, multiple sclerosis, or migraines.
   • Other Causes: Orthostatic hypotension, cardiac arrhythmias, and anxiety disorders can also lead to dizziness.

3. Clinical Evaluation:

   • A thorough history and physical examination are crucial. Key aspects include the duration, triggers, and associated symptoms of the dizziness or vertigo.
   • Oculomotor assessments and balance tests can help differentiate between peripheral and central causes.
   • Imaging, such as MRI, may be necessary if a central cause is suspected.

4. Management:

   • BPPV: Often treated with repositioning maneuvers like the Epley maneuver.
   • Vestibular Neuritis: May require corticosteroids and vestibular rehabilitation.
   • Meniere's Disease: Managed with dietary modifications, diuretics, and sometimes surgical interventions.
   • Central Causes: Treatment depends on the specific diagnosis, such as anticoagulation for stroke or migraine prophylaxis.

5. Prognosis:

   • Many cases of dizziness and vertigo improve with appropriate treatment and rehabilitation. However, persistent symptoms may require ongoing management and specialist referral.

Understanding the nuances of vertigo and dizziness is essential for effective diagnosis and management, ensuring better outcomes for patients.

Visual symptoms often accompany vertigo and dizziness, and understanding that relationship is crucial for accurate diagnosis and management. Here are some key points:

1. Visual Vertigo: This condition is characterized by dizziness and discomfort triggered by complex visual environments, such as busy patterns or moving scenes. One may experience difficulty focusing and a sensation of motion even when stationary.

2. Nystagmus: An involuntary eye movement that can occur with vertigo and dizziness, often indicating a vestibular disorder. It can cause visual disturbances and difficulty maintaining stable vision.

3. Visual Motion Sensitivity: Patients with chronic dizziness may exhibit increased sensitivity to visual motion, leading to symptoms like vertigo and unsteadiness. This is often seen in conditions like vestibular migraine and persistent postural-perceptual dizziness (PPPD).

4. Oculomotor Dysfunction: Abnormalities in eye movements, such as saccadic intrusions or impaired smooth pursuit, can be associated with central causes of vertigo and dizziness, such as cerebellar disorders.

5. Visual Disturbances in Vestibular Disorders: Conditions like Meniere's disease or vestibular neuritis can lead to visual symptoms due to the close relationship between the vestibular and visual systems.

6. Management: Addressing visual symptoms involves treating the underlying vestibular disorder, using vestibular rehabilitation, and sometimes incorporating Vision Therapy to improve oculomotor control and reduce motion sensitivity.

Understanding the interplay between visual symptoms and vestibular dysfunction is essential for comprehensive management of vertigo and dizziness.

Author

Paddy Kalish OD, JD and B.Arch Author and Blogger