Vertigo and Dizziness Vestibular Balance Disorders
Medical Author: James K.
Bredenkamp, MD, FACS
Medical Editor: Leslie J.
Schoenfield, M.D., Ph.D.
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Vertigo, Not an Easy Diagnosis
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
The room spins wildly around, and you become
intensely nauseous. No, it's a ride at your local amusement park, not the residual of
an all night party, but instead, you are challenged with
vertigo. The symptoms
are highly unpleasant and incapacitating, and the illness has a variety of
causes including:
- trauma to the inner ear,
- stroke, or
- the most common cause,
idiopathic, meaning we just don't know.
Balance is complicated. The labyrinth system (the inner ear, see diagram
below) has a
gyroscope mechanism that tells the brain where the body is in relation to the
world. To be in tune with your surroundings, the gyroscope needs to work, and
the brain needs to interpret the signals. The labyrinth can get confused (for
example, from viral infections or repeated head movements - like using a computer
to enter data or cleaning cupboards above your head), or - just because. The
cerebellum (the back part of the brain), can misinterpret the signals (for
example, due to a tumor or stroke), so vertigo is not a symptom to be taken
lightly. Fortunately, with a detailed medical history and physical exam, the doctor
should be able to distinguish loss of balance due to an inner ear problem - from
incoordination resulting from a brain problem.
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Introduction
Ponder this: if a cat is dropped upside down, it will land right side up on
all four paws. If a newborn infant is tilted backward, its eyes will roll
downward so that its gaze remains fixed on the same point. If, as you read this
article, you shake your head rapidly from side to side, the print nonetheless
will stand still. Each of these scenarios is an example of how a healthy balance
(vestibular) system compensates for daily changes in our spatial orientation.
Balance is a state of body equilibrium or stability. We often take for
granted how dependent we are on a healthy balance system. When the system breaks
down, however, patients will describe symptoms such as dizziness, vertigo,
lightheadedness, or motion sickness.
How do patients describe the symptoms caused by balance disorders?
More than two million people per year visit their doctor for vestibular
balance disorders.
These disorders are the ninth most common complaint that leads patients to
visit their primary care physicians. Furthermore, it is one of the most common
reasons elderly people seek medical advice.
Patients often describe balance problems in terms of vertigo, dizziness,
lightheadedness, and motion sickness. But, not all of these symptoms are always
caused by disorders of the vestibular system. Moreover, although one person may
describe a balance problem using one or more of these terms, another person may
use a different combination of these terms to describe the very same condition.
In fact, some people will even use the word dizziness to indicate that they
simply do not feel well. It is important, therefore, for patients to not use general
terms when describing their balance problems. Put another way, it is best for
patients to simply describe the sensation they feel without using general terms
like dizziness or vertigo.
Next: Dizziness »
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