Understanding the Causes of Vertigo

Summary

This video provides a comprehensive overview of vertigo, explaining its causes and underlying pathophysiology. Vertigo is a sensation of movement, often characterized by spinning and accompanied by nausea and sweating. It occurs due to a mismatch in sensory inputs, particularly from the vestibular system in the inner ear. The video covers both peripheral causes, like benign paroxysmal positional vertigo (BPPV), Meniere's disease, and vestibular neuritis, as well as central causes, such as posterior circulation infarction, brainstem tumors, multiple sclerosis, and vestibular migraines. Key diagnostic tests and treatment strategies are also discussed to aid in understanding and managing vertigo.

Takeaways

• 😀 Vertigo is a sensation of spinning where the person feels they or their environment are moving, often accompanied by nausea and sweating.
• 😀 The vestibular system, located in the inner ear, plays a key role in detecting head movement and maintaining balance.
• 😀 Vertigo can be caused by a mismatch between sensory inputs from vision, proprioception, and the vestibular system.
• 😀 The vestibular apparatus includes semicircular canals filled with endolymph that detect movement through shifting fluid.
• 😀 Peripheral vertigo is caused by issues in the vestibular system, while central vertigo is linked to problems in the brainstem or cerebellum.
• 😀 Benign Paroxysmal Positional Vertigo (BPPV) occurs when calcium crystals in the ear canals disrupt fluid movement, causing positional vertigo.
• 😀 Meniere's disease results from excessive endolymph buildup in the semicircular canals, leading to vertigo, hearing loss, and tinnitus.
• 😀 Vestibular neuritis, usually caused by a viral infection, leads to inflammation of the vestibular nerve and sudden-onset vertigo.
• 😀 Central causes of vertigo include posterior circulation infarction (stroke), brainstem tumors, multiple sclerosis, and vestibular migraine.
• 😀 Posterior circulation infarction causes sudden vertigo along with other neurological symptoms like limb weakness or double vision.
• 😀 Vestibular migraine causes vertigo attacks associated with visual aura and headaches, typically lasting minutes to hours.

Q & A

What is vertigo and how is it typically described by patients?

Vertigo is a sensation of movement or spinning, often described as the environment spinning or the person moving. Patients may feel like they are moving or that the room is spinning, and it is commonly accompanied by nausea, vomiting, sweating, and an overall unwell feeling.

What are the primary sensory inputs responsible for maintaining posture and balance?

The primary sensory inputs responsible for maintaining posture and balance are vision, proprioception (sensation from the joints), and signals from the vestibular system.

Where is the vestibular system located and what is its role in vertigo?

The vestibular system is located in the inner ear. It consists of three semicircular canals filled with endolymph, which detect head movements. The system helps maintain balance and coordinates eye movements by sending sensory information to the brain.

What is benign paroxysmal positional vertigo (BPPV), and what causes it?

BPPV is a condition caused by the displacement of calcium carbonate crystals (otoconia) into the semicircular canals. These crystals disrupt normal fluid movement in the canals, triggering vertigo. It can be triggered by viral infections, head trauma, aging, or occur without a clear cause.

How is BPPV diagnosed?

BPPV is typically diagnosed using the Dix-Hallpike maneuver, a test that involves specific head movements to provoke vertigo and identify the condition.

What are the symptoms and causes of Meniere's disease?

Meniere's disease is characterized by vertigo, tinnitus (ringing in the ear), hearing loss, and a sensation of fullness in the ear. It is caused by an excessive buildup of endolymph in the semicircular canals, leading to higher pressure that disrupts the vestibular system.

What is vestibular neuritis and how is it caused?

Vestibular neuritis is inflammation of the vestibular nerve, often caused by a viral infection. It leads to a mismatch of signals from the vestibular system, causing vertigo that typically lasts for weeks and gradually resolves.

What are the central causes of vertigo, and how do they differ from peripheral causes?

Central causes of vertigo involve the brainstem or cerebellum and can include posterior circulation infarction (stroke), tumors, multiple sclerosis, and vestibular migraines. Unlike peripheral causes, central vertigo is not positional and results from disruptions in the brain's interpretation of vestibular signals.

How do posterior circulation infarctions cause vertigo?

Posterior circulation infarctions, which are strokes in the brainstem or cerebellum, lead to sudden-onset vertigo, often accompanied by other neurological symptoms like ataxia, double vision, cranial nerve defects, or limb weakness.

What treatment options are available for benign paroxysmal positional vertigo (BPPV)?

BPPV is treated with repositioning maneuvers, such as the Epley maneuver, which helps move the displaced crystals back to their proper location in the semicircular canals.