In vertigo, attacks are often characterized by a spinning dizziness and even symptoms of autonomic dysregulation such as nausea, vomiting, and cold sweats. It is important to note that vertigo usually reflects a lesion in the vestibular area and it is a symptom, not a disease. There are two main types namely: true vertigo and pseudovertigo.
I. Etiology
There are many diseases that cause vestibular lesions, in general, the following etiologies can be summarized.
1. Vestibular lesions: The lesions in the vestibular area happen to be located in a complex zone neuroanatomically, and this small area has a traffic network from the corticospinal tract, cerebellum, pontine brain, brainstem, and the eighth pair of brain nerves. Therefore, lesions in this area can be differentiated into peripheral and central nerves based on their neuroanatomical relationship. In the case of peripheral nerve disease, vertigo attacks are often accompanied by tinnitus, hearing loss, and eye tremor in a characteristic peripheral form. In the case of vertigo of central nerve disease, the eye tremor takes on a specific brainstem form.
II. Peripheral nerve diseases
1. Benign paroxysmal vertigo.
This type of vertigo is very common in outpatient clinics, it occurs in elderly people, often with a specific evoked position, and after a few minutes of attack, if it stops not moving, the vertigo stops, but if the position changes again, the vertigo will come on again. Without any treatment, the symptoms will resolve on their own in six months. Regarding the cause of this disease, the popular theory is that the otoliths in the inner ear, which are responsible for the balance, degenerate and fall off, forming small free particles that affect the flow of endolymph when the posture changes, causing vertigo. Another theory is that a small pathway grows out of the middle ear to reach the inner ear, which affects the pressure difference between the left and right sides and causes vertigo.
2. Meniere’s disease.
It is still a disease full of myths. It is known by anatomical evidence that the main lesion of Meniere’s disease lies in unexplained localized edema of the endolymph and destruction of the auditory nerve and semicircular canal cells. Patients experience tinnitus, ear swelling, hearing loss, and eye tremors. The attacks are paroxysmal, lasting from a few minutes to a few hours at a time, and then gradually resolve. Subsequently, the attacks occur irregularly over several months, and with each attack, some hearing is lost, and eventually complete deafness can occur.
3. Acute Labyrinthitis.
Acute labyrinthitis is often associated with a viral infection. Such cases usually begin with symptoms of an upper respiratory tract infection, followed by a slow onset of dizziness, with the most severe dizziness occurring after about three more days, followed by a slow recovery over a period of about three to six weeks.
4. Ototoxic substances or drugs.
Certain common antibiotic drugs, due to the patient’s constitution, can cause temporary hearing loss after use, and vertigo is one of the symptoms, which can usually be recovered after stopping the drug.
5. Auditory neuroma.
This is the eighth benign tumor on the brain nerve. Tumors in the brain, regardless of whether they are histologically benign or malignant, are bad as long as they can press on important nerves and cause neurological symptoms. As mentioned earlier, the nerve network in the vestibular region is quite complex and important. Therefore, compression of the auditory nerve will cause hearing loss, compression of the vestibule will cause vertigo, compression of the cerebellum will cause balance disorders, and if the junction between the cerebellum and the pontine brain is invaded, many brainstem symptoms will appear. Generally speaking, the symptoms caused by tumorigenic diseases will become more and more severe with time and the more difficult to open. Therefore, early detection and early treatment will result in fewer sequelae. Unfortunately, the tumor is usually very large by the time the patient has symptoms.
Central nervous system diseases
1.Multiple sclerosis.
This is a terrible disease of progressive demyelination of the central nervous system. If it affects the vestibular nerve, it will cause vertigo, in addition, it will also affect many nerve lesions and related symptoms in the brainstem area, and lesions of the optic nerve are quite common. Initially, the disease will be relieved after an attack, but with each subsequent attack, the patient’s condition will get worse and the remission will not return to the original condition, and the course of the disease shows a stepped down curve.
2.Disorder of the circulation of the vertebral basilar artery.
This type of vertigo is caused by circulatory disorders in the blood vessels of the brain, so when it strikes, it is occasionally accompanied by symptoms related to stroke, such as speech impairment, visual impairment, sensory nerve paralysis, limb weakness or paralysis, etc. If the symptoms resolve within a day, it is called a paroxysmal ischemic stroke. If the symptoms are mild and resolve in a few minutes, only the diagnosis of lower vertebral artery circulation disorder can be made.
3.Central nervous system drugs:
Many central nervous system depressant drugs can cause vertigo with overdose. Proper monitoring of drug concentrations is necessary.
Other symptoms very similar to vertigo such as syncope, dizziness, headache, etc. are very strictly defined in medicine, and the general public often mixes these symptoms when seeking medical attention.
4. Causes of vertigo
(1) Anemia: If elderly people have dizziness, weakness and pale face, they should go to the hospital to check if they are anemic. Elderly people who do not pay attention to nutritional health care can easily suffer from anemia. In addition, anemia can be secondary to dyspepsia, peptic ulcer, gastrointestinal bleeding, and chronic inflammatory diseases in elderly patients.
(2) High blood viscosity: hyperlipidemia and thrombocythemia can cause high blood viscosity and slow blood flow, resulting in insufficient blood supply to the brain and the occurrence of symptoms such as easy fatigue, dizziness and weakness. Among the many causes of hyperlipidemia, the most important one is the unreasonable structure of the usual diet.
(3) Arteriosclerosis: Patients feel dizzy, and often suffer from insomnia, tinnitus, emotional instability, forgetfulness, and numbness of the limbs. Cerebral arteriosclerosis makes the inner diameter of blood vessels smaller and blood flow in the brain decreases, resulting in insufficient blood and oxygen supply to the brain, causing dizziness.
(4) Cervical spondylosis: Tightness in the neck, limited flexibility, occasional pain, numbness and coldness of the fingers, and a feeling of heaviness often occur. Cervical spine hyperplasia squeezes the vertebral artery in the neck, causing insufficient blood supply to the brain, which is the main cause of dizziness caused by this disease.
(5) Hypertension: In addition to dizziness, patients with hypertension are often accompanied by discomfort such as head swelling, panic, irritability, tinnitus, and insomnia.
(6) Heart disease: In the early stage of coronary heart disease, some people may feel headache, dizziness, weakness of limbs, and difficulty in concentration. This is mainly due to atherosclerosis of the coronary arteries of the heart, which causes dizziness due to insufficient blood supply.
(7) Meniere’s syndrome: Meniere’s syndrome is an inner ear disease, and vertigo is the most important manifestation of Meniere’s syndrome.
(8) Blood diseases: Leukemia, pernicious anemia, and blood hypercoagulable diseases can cause dizziness, which can be confirmed by blood system examination.
(9) Insufficient exercise: Some people usually lack exercise and have weak cardiorespiratory function, so if they suddenly exercise vigorously, dizziness can appear. If the exercise time is too long, the nutrients in the body will be depleted too much and the blood glucose concentration will be lowered, or if the breathing is accelerated when the exercise is intense, the oxygen supply in the body will be insufficient.
(10) Inner ear diseases: otogenic vertigo is common in Meniere’s syndrome, vaginitis, vestibular neuritis, etc.