Dizziness and Vertigo

  • Basics

    While the word "dizziness" is often used to describe a feeling of faintness or loss of balance, true dizziness, or vertigo, is a false sensation that you or your environment are moving or spinning. The classic case of vertigo involves being in a high place and feeling like you are falling when you are not. A person suffering a bout of vertigo might also perceive that his surroundings are spinning —as if on a merry–go–round — even though he or she is stationary. Nausea and vomiting can accompany vertigo, which may last as little as a few moments or as long as a few days. Complaints of "dizziness" usually are not vertigo.

    Dizziness is one of the top reasons that Americans go to their doctors, and is responsible for more than 5 million physician visits every year.

  • Causes

    During vertigo, the sensory organs that control balance and spatial orientation — usually those situated in the inner ear — send confusing signals to the brain [Figure 1].

    Abnormalities in the inner ear, in the nerves that connect it to the brain, or in the brain itself may be responsible for vertigo. The most common cause of vertigo is labyrinthitis, a viral or bacterial infection of the system of fluid–filled tubes and sacs that make up the inner ear (labyrinth). Conditions that affect the inner ear, such as Meniere's disease and benign paroxysmal positional vertigo (BPPV), are other possible causes. In Meniere's disease, swelling in the ear canal damages hair cells that respond to motion. In BPPV, debrisin the ear canal interferes with spatial orientation.

    Brain infections, tumors, head trauma, and seizures can all bring on vertigo. Blood flow interruptions to the ear or brain (such as those that occur during a transient ischemic attack or mini–stroke) sometimes cause vertigo.

    Certain drugs can induce vertigo Table 01. Alcohol and the antibiotics streptomycin and gentamycin have been known to damage the inner ear. People taking diuretics and other medications that lower blood pressure sometimes get vertigo when they stand up too quickly. Drugs used for depression, anxiety disorders, and psychosis — as well as the conditions themselves — may also provoke an attack.

    Table 1.  Drugs That Can Cause Dizziness

    Drug class
    Aminoglycosides
    Antihypertensive, diuretic, or dopaminergic agents
    Vasodilators
    Phenothiazines
    Tranquilizers, antidepressants
    Anticonvulsants
    Hypnotics
    Analgesics
    Alcohol
    Caffeine
    Tobacco products

    Motion sickness is a fairly common cause of vertigo. Some people are sensitive to the rocking on a boat (seasickness), as the inner ear's equilibrium mechanisms may have trouble adjusting to unfamiliar head movements. With car sickness, the eyes and ears send conflicting messages to the brain. Both can cause a nauseating, whirling sensation that leads to vomiting.

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