Vertigo

Definition

Vertigo is a symptom characterized by the false sensation of motion, often described as spinning, usually due to dysfunction of the vestibular system or central nervous system.

Epidemiology

• Prevalence: ~20–30% of adults experience vertigo at some point in life.
• More common in older adults (>60 years).
• Affects both sexes, with a slight female predominance.
• Can be acute, recurrent, or chronic depending on etiology.
• Common cause of emergency visits and falls in elderly patients.

Etiology

• Peripheral causes: Benign paroxysmal positional vertigo (BPPV), Ménière’s disease, vestibular neuritis, labyrinthitis.
• Central causes: stroke (posterior circulation), multiple sclerosis, tumors, migraine-associated vertigo.
• Medication-induced: ototoxic drugs (aminoglycosides, loop diuretics), antihypertensives.
• Systemic causes: anemia, hypoglycemia, dehydration, hypotension.
• Other: post-traumatic vestibular dysfunction, vestibular migraine.

Pathophysiology

• Peripheral vertigo: dysfunction of vestibular apparatus or vestibular nerve.
• Central vertigo: lesions affecting brainstem, cerebellum, or vestibular pathways.
• Mismatch between visual, vestibular, and proprioceptive inputs leads to sensation of spinning.
• BPPV: dislodged otoliths in semicircular canals trigger abnormal endolymph flow.
• Ménière’s disease: endolymphatic hydrops cause episodic vertigo with hearing loss.