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- Sensation of movement (“room spinning”) when no movement is actually occurring; results from peripheral/central causes, or may be induced by medications/anxiety disorders
- Important to distinguish between vertigo and presyncope (patient feels lightheaded; vision and hearing may become obscured)
- System(s) affected: Nervous
- Synonym(s): Dizziness; Acute vestibular neuronitis; Labyrinthitis; Benign paroxysmal positional vertigo (BPPV)
- Vertigo accounts for 54% of cases of dizziness reported in primary care; >90% of these patients are diagnosed with peripheral causes, such as BPPV.
- Predominant sex: Female = Male; women are more likely to experience central causes, particularly vertiginous migraine.
Patients who are elderly and have risk factors for cerebrovascular disease (CVD) are more likely to experience central causes.
- Ranges from 5–10% within the general population
- Lifetime prevalence for BPPV is 2.4%.
- History of migraines
- History of CVD/risk factors for CVD
- Use of ototoxic medications
- Perilymphatic fistula
- Heavy weight bearing
- Psychosocial stress/depression
- Exposure to toxins
Family history of CVD/migraines may indicate higher risk of central causes.
- Precautions to avoid injuries from falls that may occur secondary to imbalance
- If due to motion sickness, consider pretreatment with anticholinergics, such as scopolamine.
Dysfunction of the rotational velocity sensors of the inner ear results in asymmetric central processing. This is related to the combination of sensory disturbance of motion and malfunction of the central vestibular apparatus.
- Peripheral causes: Acute labyrinthitis, acute vestibular neuronitis, BPPV, herpes-zoster oticus, cholesteatoma, Ménière disease, otosclerosis
- Central causes: Cerebellar tumor, CVD, migraine, multiple sclerosis
- Drug causes: Psychotropic agents (antipsychotics, antidepressants, anxiolytics, anticonvulsants, mood stabilizers), aspirin, aminoglycosides, furosemide, amiodarone
- Other causes: Cervical, psychological