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DIZZINESS AND VERTIGO
Extracted from Dizziness and Vertigo, a guide for General
Professor Dr. W.J. Oosterveld The Hague
Vertigo is a sensation as if the external world is revolving around the patient or as
if (s)he him/herself is revolving in space. Dizziness is a disturbed sense of relationship
to space, it is a sensation of unsteadiness with a feeling of movement with the head,
giddiness. It is not possible to give a much more accurate description, as each patient
suffering from dizziness will give a different description of the complaint.
Patients use terms such as spinning sensation, giddiness,
light headedness, dizzy spells or a feeling of unsteadiness. Vertigo and dizziness are
only symptoms. It is never a syndrome, any more than a fever or headache are.
FORMS AND CAUSES
On the basis of the history, five main forms can be differentiated, while on the basis
of test results it can also be decided whether the underlying disorder is of a possible
severe character - in other words, whether the GP can treat the problem or whether the
patient must be referred on for further diagnosis.
These five main forms are :
- Paroxysmal vertigo: the sudden attack which comes on
quickly, lasts only a short time (from seconds to a few hours) and then goes away again
just as quickly. Recurs after symptom-free intervals.
- The sudden, intense attack, fading away much more slowly
than the first type: it takes days and even weeks to disappear completely.
- Chronic vertigo: often not serious but - with small flare
ups - permanently present. Lasts for months without any change.
- Positioning vertigo: occurs following sudden movements of
the head, often in one particular plane.
- Dizziness spells: lasting a few seconds, occurring
Almost 100 different syndromes can be accompanied by
vertigo. In many cases, it is not possible to specify one particular type of vertigo which
is specific to a syndrome.
FORM 1: PAROXYSMAL VERTIGO
The sudden attack which goes away again quickly generally has two causes which are not
straight forward: vertebrobasilar insufficiency and cervical vertigo.
On the other hand, these are disorders which can be
detected very well at the outset and treated: benign paroxysmal positional vertigo (BBPV),
orthostatic vertigo, and hyperventilation. And then there are disorders requiring
assessment by a medical specialist: Ménière's disease (audiological examination
compulsory), hypoglycaemia and syncope.
FORM 2: SINGLE ATTACK OF VERTIGO
The severe attack which does not go away quickly, but only diminishes slowly in the
course of days or weeks, may be a symptom of vestibular neuritis which practically always
disappears spontaneously and without after-effect. It is therefore not severe.
A unilateral, acute labyrinthine outburst can sometimes
already be apparent from the history, but has to be proved.
Occasionally, this type also occurs with multiple sclerosis
(MS), especially at the start of the illness; this, like labyrinthine vascular accidents,
(peri)labyrinthitis, and herpes zoster oticus, has to be referred to a specialist.
FORM 3: CHRONIC VERTIGO
Chronic vertigo is seen quite often in association with atherosclerosis cerebri.
Whether one still decides to refer such a patient to a specialist will thus depend how
well one knows one's patient. This applies almost equally in the case of hypertension.
Chronic vertigo can sometimes occur with chronic otitis, where it may have a nagging
character and be intensified by movements.
Chronic vertigo may also point to a serious disorder of the
central nervous system. Post-traumatic vertigo is also sometimes chronic in nature.
FORM 4: POSITIONING VERTIGO
This vertigo occurs when turning to a particular posture. An important example of this
is BPPV. Where positioning vertigo continues in a certain position, one talks of
"positional vertigo". Persistent positional vertigo requires further
investigation because it can be a symptom of a cerebellar disorder.
FORM 5: DIZZINESS SPELLS
Dizziness spells can occur at any age, but are nevertheless more prevalent among older
The causes can vary considerably, but are basically due to
cardiovascular factors and hyper- or hypotension.
With vertigo a specialist examination is desirable in the
SPECIALIST EXAMINATION IN THE CASE OF VERTIGO
Serious vertigo which is disabling.
- Vertigo lasting longer than 4 weeks.
- Vestibular disorders, whether or not accompanied by vertigo.
- Changes in hearing performance.
- Nystagmus, or other abnormal eye movements.
A few syndromes in which vertigo is an important symptom:
BENIGN PAROXYSMAL POSITIONAL VERTIGO
Dizziness occurring when a person lies down, often when the head or body is held in a
particular way. The dizziness appears after a latent period of a few seconds, lasts no
more than 30 seconds and quickly passes. This provocation is self-limiting. The cause of
the syndrome is not known. Treatment consists of adaptation
exercises. .. further information
Attacks of vertigo lasting minutes to hours, accompanied by vegetative symptoms such
as tinnitus in one ear and varying but gradually worrying hearing loss in that ear.
The syndrome occurs with various internal disorders, and
also as an independent disorder, when it is called Ménière's disease.
The cause is unclear.
The treatment consists of pharmacotherapy with anti-vertigo
Over-active respiration can cause reduced carbon dioxide tension in the blood, which
can lead to cerebral ischaemia. This can manifest itself in visual disturbances and
changes in consciousness. Dizziness in the form of giddiness is often reported. Anxiety,
tachycardia and tetany symptoms in the hands and fingers are found in this syndrome.
Hyperventilation sometimes also occurs as a result of
stress situations. It is necessary to watch out for the latent form of this syndrome.
The treatment consists of counselling, the advice to breath
into a bag in the event of an attack, and sometimes sedation.
Vertigo in children involves the same syndromes as those found in older people. One
particular form occurring in children between the ages of 4 and 14 is "juvenile
vertigo". This involves attacks lasting a few minutes in which the main thing is
anxiety. The syndrome always disappears again spontaneously within a few months.
The treatment consists of a low dose of antiepiletics where
the frequency of the attacks is more than one a week..
Vertigo often occurs in the elderly. Above the age of 65, half of all patients
sometimes have trouble with dizziness. This can have various causes, though
atherosclerosis cerebri certainly plays a big part.
Treatment actually consists solely of pharmacotherapy,
though here it is important to avoid as far as possible drugs which cause drowsiness as a
Acute vertigo with vegetative symptoms caused by viral inflammation of one vestibular
nerve, mostly following infection of the upper respiratory tract. The vertigo subsides
within the course of days to weeks. There are never any hearing problems.
The treatment is just wrapping up warm. In the case of
severe vertigo, pharmacotherapy is given. The condition clears up spontaneously in 3 to 6
Vertigo sometimes appears as a side effect of migraine. The diagnosis is clear from
the prominent symptoms of migraine. Specific therapy to combat vertigo is necessary here
in very exceptional cases only.
A natural occurrence which practically everyone experiences at one time or another. It
is a complex of symptoms in response to an unusual pattern of stimuli from the vestibular
system. Vegetative symptoms with a strong feeling of being unwell are the most prominent
symptoms. Motion sickness occurs more in children than in older people, and more in
females than in males.
Prevention and treatment consists of anti-motion sickness
drugs, the strongest active component of which is cinnarizine.
East Valley Division General Practice, Victoria,
Level 1, Pathology Building, Repatriation Campus, A&RMC,
Heidelberg West VIC 3081. .. map
Phone: 03 9496 4333, Fax: 03 9496 4349, Email: email@example.com,
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