Vertigo

• Vertigo

  A descriptive term for a sensation that there is movement between the patient and their environment. They may feel they are moving or that the room is moving. Often this is a horizontal spinning sensation, similar to how you feel after turning in circles then stopping abruptly.
• Vertigo is often associated with nausea, vomiting, sweating and feeling generally unwell
• Sensory inputs responsible for maintaining balance and posture

  • Vision
  • Proprioception
  • Signals from the vestibular system
• Vertigo

  Caused by a mismatch between these sensory inputs
• Vestibular system

  • The most important sensory system to understand when learning about vertigo
  • Located in the inner ear
  • Consists of three loops called the semicircular canals that are filled with a fluid called endolymph
  • Semicircular canals are oriented in different directions to detect various movements of the head
  • As the head turns, the fluid shifts inside the canals
  • Fluid shift is detected by tiny hairs called stereocilia found in a section of the canal called the ampulla
  • Sensory input of shifting fluid is transmitted to the brain by the vestibular nerve and lets the brain know that the head is moving in a particular direction
• Vestibular nerve


  • Carries signals from the vestibular apparatus to the vestibular nucleus in the brainstem and the cerebellum
  • The vestibular nucleus then sends signals to the oculomotor, trochlear and abducens nuclei that control eye movements and the thalamus, spinal cord and cerebellum
  • The cerebellum is responsible for coordinating movement throughout the body
• Vertigo


  Can be caused by either a peripheral problem, usually affecting the vestibular system or a central problem, usually involving the brainstem or the cerebellum
• Common peripheral causes of vertigo

  • Benign paroxysmal positional vertigo
  • Ménière's disease
  • Vestibular neuronitis
  • Labyrinthitis
• Benign paroxysmal positional vertigo (BPPV)

  • Caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals
  • Symptoms are usually positional, because movement is required to confuse the system
  • Attacks of vertigo are triggered by movement and can last around a minute before the symptoms settle
  • Often symptoms occur over several weeks and then resolve, then can reoccur weeks or months later