“Hallucination Of Motion” is the simplest definition one can find in the textbook for Vertigo. It is frequently a sensation of rotation (Spinning or Turning). It may be one of self rotation [subjective] or rotation of the environment [objective].
Dizziness on the other hand is best defined as a sensation of the loss of relationship to ones surroundings. By definition, all vertiginous patients simultaneously feel dizzy.
The central vestibular systems get inputs from three different sources. They are:
- Inner ear (Labyrinthine)
- Cervical joints (proprioceptors) - Whether the proprioceptive system can produce vertigo is debatable though!
As there are inputs from sense organs involving three different systems, there is a multitude of causes which can result in vertigo.
- Labyrinthine causes - BPPV (Benign Paroxysmal Postural Vertigo), Vestibular neuronitis, Menieres disease (increased accumulation of Endolymph in the vestibule).
- Eye Causes - Oscillopsia, Nystagmus.
- Joints - Cervical Spondylitis.
- Others - Vascular steal syndrome Diabetes mellitus, hypercholesterolemia, Orthostatic Hypotension, etc.
The treatment hence lies in pinpointing the site of the lesion. The treatment of an acute attack involves sedatives like intravenous Diazepam, Stemetil, etc. Labyrinthine sedatives like cinnarizine forms the mainstay to tide over the crisis.
Once the acute attack settles down, one must divert ones resources to finding the cause of vertigo.A systematic approach is required to isolate the involved system and direct the treatment accordingly. The following tests are routinely performed.
- Neuro Vestibular tests - Spontaneous and Induced nytagmus, Romberg's test, Tandem walking
- Cerebellar tests for Dysmetria, Dysdiadokokinesis
- Tendon reflexes
- Cervical Xray, Random blood sugar, Serum cholesterol.
If the labyrinthine is found to be the culprit, specialized tests are undertaken. They are - Caloric test, Unterberger's test & Dix Hallpike's maneuver.These tests are mainly done to locate the side of the lesion. Once the side has been identified, definitive treatment is started.
The definitive treatment for BPPV is Epley's maneuver which gives a dramatic relief to the patients.
In case of other causes of labyrinthine vertigo, Betahistidine tablets are given for a period of time till Vestibular Habituation takes place. Labyrinthine sedative like Cinarizine is best avoided on the long run as it will prevent the habituation. Vestibular habituaton exercises like Cawthorne Cooksey exercises are to be performed to hasten the habituaton.