When patient presents with dizziness, the initial step is to differentiate if the symptom is lightheadedness or vertigo. This is essential since the evaluation and treatment differs. Lightheadedness is most likely related to cardiac etiology or blood pressure changes. Vertigo on the other hand is neurologic. If it is lightheadedness, we try to assess for change in heart or blood pressure. Often medications can cause dizziness.
Vertigo is divided into peripheral and central. Peripheral vertigo is caused by a dysfunction in the vestibular system outside the brain (inner ear). There are three tubes in the inner ear containing fluid and hair cells that control balance. Any problem within these tubes such as infection, inflammation or calcium particles causes vertigo. Based on the history and physical examination, we are able to determine the etiology of this type of vertigo. Examples of peripheral vertigo syndromes include, benign positional vertigo, vestibular neuritis and Meniere’s syndrome. Each has specific presentation that differentiates it from the others. Treatment of the peripheral vertigo depends on the etiology. This can include medications to suppress the vertigo and specific exercises (Epley maneuver) that can improve the symptoms.
Central vertigo involves the vestibular system that is within the brain. Causes of central vertigo include stroke, multiple sclerosis, masses or tumors. Typically central vertigo is associated with other symptoms such as unsteadiness or gait disturbances, numbness, tingling sensation, visual changes, and/or weakness. Since the central vertigo is more serious and requires immediate action and treatment the workup for central vertigo must include an MRI and MRA of the brain, possibly carotid ultrasound and the treatment depending on the causes listed above.
In our office, we provide vestibular rehabilitation where there is specific equipment to help desensitize the vestibular system, thus helping in improve symptoms dramatically.