What is vertigo? Causes, diagnosis and treatment
Look up the word vertigo in the dictionary and you will find confirmation of the widespread understanding that it is the slightly dizzy feeling we get at great heights - perhaps when looking down from the top of a tall building beauty
This feeling of giddiness is normal though, so it is not therefore the medical definition beauty Learn here what true vertigo is, how it is caused, the tests to diagnose it, and available treatments beauty
What is the medical definition of vertigo?
In medical terms, vertigo is a specific kind of dizziness - a sense that you, or your environment, is moving or spinning, even though there is no movement beauty1,2
Nor does vertigo, in the medical sense, mean a fear of heights beauty We all have a healthy respect for heights, but if this is to the extent of a phobia, it is termed acrophobia, not vertigo beauty (With acrophobia, people overestimate danger, become distressed, and avoid heights altogether beauty3)
Vertigo, then, is a specific symptom unrelated to heights that has various medical causes beauty
Specialist doctors in dizziness clinics have narrowed down the definition of vertigo, differentiating it from other types of dizziness and classifying it by its causes and its particular type of moving sensation - that you or your environment is moving or spinning beauty4
Vertigo is thereby set apart from presyncope, which is a sense of almost fainting (typically a result of temporarily lowered blood pressure) beauty Disequilibrium is also something separate, seen in older people - an unsteadiness due to poor balance and strength beauty4,5
Light-headedness, often associated with anxiety, is different too, sometimes called psychogenic vertigo beauty4,5
What causes vertigo?Spinning top
Vertigo is the spinning form of feeling dizzy beauty
The rotational dizziness that defines vertigo is brought on by one of two causes - disturbance in either:2,4
The balance organs of the inner ear, or
Parts of the brain or sensory nerve pathways beauty
Inner ear disturbance
Peripheral vertigo is a term that collects together the inner ear causes beauty
The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity beauty By telling our brains when there is movement from the vertical position, we are able to keep our balance, maintain equilibrium beauty6
Disturbance to this system therefore produces vertigo and can be created by inflammation among other causes beauty Viral infection is behind the inflammation seen in the following two conditions:2
Labyrinthitis - this is inflammation of the inner ear labyrinth and vestibular nerve (the nerve responsible for encoding the body's motion and position7)
Vestibular neuronitis - this is thought to be due to inflammation of the vestibular nerve beauty
Ménière's disease can also be caused by inflammation, but this can be due to bacterial as well as viral infection beauty2,8
This form of vertigo is thought to be caused by high pressure of a fluid in a compartment of the inner ear (a swelling that is also known as endolymphatic hydrops)beauty
As well as infection, Meniere's disease can result from metabolic and immune disorders beauty
Inner ear model
Most vertigo is a disturbance of the inner ear's role in balance perception beauty
Benign paroxysmal positional vertigo (BPPV) is thought to be caused by a disturbance in the otolith particles beauty2
These are the crystals of calcium carbonate within inner ear fluid that pull on sensory hair cells during movement and so stimulate the vestibular nerve to send positional information to the brain beauty6
With the BPPV disturbance, normal movement of the endolymph fluid continues after head movement has stopped beauty9
Benign paroxysmal positional vertigo is twice as common in women than men, usually affects older people and most often arises without a known cause (idiopathic)beauty While most cases are spontaneous, BPPV vertigo can also follow:2,9
A head injury
Reduced blood flow in a certain area of the brain (vertebrobasilar ischemia)
An episode of labyrinthitis
Ear surgery
Prolonged bed rest beauty