Vertigo

Disease Description (Causes and Symptoms)

Definition: Vertigo is a type of dizziness that involves the sensation that oneself or the surroundings are rotating or spinning.
Major causes

• Peripheral (inner ear·vestibular organs): benign paroxysmal positional vertigo (BPPV, otolithiasis), vestibular neuritis (Bérnier), Meniere’s disease (endolymphatic hydrops), labyrinthitis, complications such as chronic otitis media, etc.
• Central (brain-related): brainstem·cerebellar ischemia (stroke), brain tumors, multiple sclerosis, migrainous dizziness, etc.
• Other: temporary reduction in cerebral blood flow (hypotension), medications (antihypertensive drugs, sedatives, etc.), metabolic abnormalities (hypoglycemia, anemia)
  Pathophysiology summary: Peripheral vertigo results from abnormalities of the vestibular organs (semicircular canals·cochlea) or vestibular nerve, distorting information about the body’s position and movement and causing a spinning sensation and characteristic nystagmus. Central vertigo results from abnormalities in vestibular relays in the brainstem·cerebellum and is accompanied by non-rotational dizziness, persistent imbalance, and various neurological deficits.
  Major symptoms
• Nausea·vomiting, sweating, and oscillatory nystagmus occurring with rotational dizziness (a spinning sensation)
• Duration: seconds (BPPV) to hours (Meniere’s disease·migraine) to days (vestibular neuritis), or persistent (central lesions)
• Hearing loss·tinnitus (when accompanied by Meniere’s disease or inner-ear disease)
• Associated symptoms: neurological abnormalities such as diplopia, slurred speech, limb weakness, and gait ataxia suggest a central cause

Treatment Methods

General principles: Identifying the cause comes first. If a central cause (such as stroke) is suspected, emergency diagnosis·treatment is necessary. Peripheral vertigo is highly likely to improve with standard treatment according to the cause. Medication treatment

• Symptom relief: antiemetics (such as ondansetron), vestibular suppressants·sedatives (meclizine, diazepam, etc.) — short-term use is recommended
• Early vestibular neuritis: high-dose steroids (in some cases) to suppress inflammation
• Meniere’s disease: diuretics (with a low-salt diet), betahistine (used in some countries)
  Procedures·surgery
• BPPV: Epley and other canalith repositioning procedures (positional correction procedures) — noninvasive and effective
• Refractory Meniere’s disease: endolymphatic sac decompression, intratympanic (transtympanic) steroid injection, or gentamicin (risk of hearing loss)
• Lesions causing severe otitis media·tumors and other conditions are treated with medication·surgery as appropriate
  Rehabilitation
• Vestibular rehabilitation (balance training): effective for chronic imbalance·reduced vestibular function
  Precautions·risk of complications
• Symptoms requiring immediate emergency medical care: sudden severe dizziness + unilateral weakness·sensory loss, speech impairment, diplopia, severe headache, decreased consciousness, sudden hearing loss, etc.
• Medication side effects (sedation, drowsiness, risk of falls), and possible hearing damage with gentamicin use
• Complications: falls·fractures, chronic imbalance·anxiety·depression, permanent neurological damage if treatment is delayed (central causes), hearing loss (Meniere’s disease, etc.)

Checklist Before an Outpatient Visit (Materials & Example Questions)

Materials/documents to bring

• A list of medications currently being taken (including prescriptions·OTC medications·herbal medicines) and the times they are taken
• Symptom record: date of onset, duration (seconds/minutes/hours/days), frequency, triggers (changes in position, noise, etc.), and factors that improve·worsen symptoms
• A record of any recent changes in hearing (hearing loss·tinnitus)
• History of recent head trauma or infection (upper respiratory tract infection)
• Copies of previous test results and imaging (MRI, CT, hearing tests), if available
• Records of blood pressure·blood glucose, if possible, and whether any falls or injuries occurred Information to tell the doctor first at the outpatient visit (examples)
• "When exactly did the dizziness begin, and what was the first triggering situation?"
• "Do the symptoms become worse when you sit or lie down?"
• "Have you recently had symptoms such as headache, speech impairment, or weakness in your arms or legs?"

Examples of General Questions to Ask the Doctor

• "What is the most likely cause of this dizziness? Do I need additional tests (for example, an MRI or hearing test)?"
• "What are the main side effects of the medication you prescribed, and what limitations will there be on daily activities (driving, operating machinery)?"
• "Do I need rehabilitation (vestibular rehabilitation)? When should it begin, and how long will it last?"

Examples of Disease-Specific Questions

• If BPPV is suspected: "What were the results of the Dix–Hallpike test? Can the Epley maneuver (positional correction procedure) be performed right away?"
• If vestibular neuritis or a central cause is suspected: "What emergency tests (MRI/blood tests) do you recommend to rule out a central cause (such as stroke)?"

(Note: The information above is general medical guidance. If symptoms are severe or any of the emergency signs above are present, you should visit an emergency room immediately.)