Dizziness

Introduction

Vertigo is a false sensation of movement of oneself or one's environment, most often rotatory. It is common: about 15% of the population consults for vertigo at least once in their lives. The majority of vertigo cases are of peripheral origin (inner ear) and benign, but some can reflect a serious central cause (stroke). Identifying the origin of the vertigo is essential to adapt the treatment. Vertigo has a strong impact on quality of life, autonomy, and the risk of falling, especially in the elderly.

If you experience intense vertigo, especially if accompanied by neurological signs, first contact your treating physician. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our app available on the App Store and Google Play.

Who is at risk?

Anyone can experience vertigo. Those most exposed are: the elderly (vestibular aging, polypharmacy, comorbidities), patients with a history of ENT issues (ear infections, trauma), cardiovascular diseases (hypertension, arrhythmias), diabetes, migraines, anxiety, cervical disorders, or those taking certain medications (ototoxic, antihypertensive, sedative). Travelers and athletes may experience vertigo related to motion sickness or diving.

Symptoms and Characterization of Vertigo

The precision of the complaint is essential. Several sensations are often grouped under the term "vertigo".

Definitions and Types

• True vertigo: sensation of spinning, swaying, or movement. Vestibular or neurological origin.

• Pseudovertigo or instability: sensation of insecurity while walking, without spinning.

• Lightheadedness or faintness: feel of imminent loss of consciousness, cardiovascular origin.

• Visual disturbances: sensation of the head spinning after a sudden movement, visual fatigue.

Main Associated Symptoms

• Nausea and vomitting.

• Sweating, paleness.

• Tinnitus and hearing loss (vestibular or cochlear origin).

• Nystagmus (abnormal eye movements).

• Balance disorders, deviation during walking.

• Depending on the cause: neurological signs, headache, fever.

When to Seek Emergency Consultation?

An emergency consultation is necessary in case of signs suggestive of a central cause:

• Vertigo associated with neurological signs: speech impairment, paralysis, visual disturbances, swallowing difficulties, motor or sensory deficit — call 144 (suspected stroke).

• Vertigo with sudden and intense headache.

• Persistent rotatory vertigo with inability to stand.

• Vertigo with loss of consciousness, palpitations, chest pain (suspected cardiovascular issue).

• Vertigo after a head or cervical trauma.

• Febrile vertigo or with neck stiffness.

• Vertigo in the elderly, especially after a fall.

• Vertigo in pregnant women or in case of recently taking a new medication.

What to do before calling Docadom? Sit or lie down quietly, avoid sudden head movements, and first contact your treating physician. If they are unreachable or if you need a home doctor outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of neurological signs, sudden headache, or chest pain, dial 144 without delay.

Causes of Vertigo

The causes are numerous. We distinguish between peripheral (inner ear, vestibular nerve) and central (brain, cerebellum, brainstem) vertigo.

Peripheral Causes (most common)

• Benign Paroxysmal Positional Vertigo (BPPV): the most common cause. Brief attacks (< 1 minute) triggered by certain movements of the head. Related to otolith crystals displaced in the semicircular canals.

• Ménière's disease: attacks of rotatory vertigo (> 20 minutes), associated with tinnitus and fluctuating hearing loss.

• Vestibular neuritis: intense, prolonged vertigo, often after a viral episode. Without hearing loss.

• Labyrinthitis: combination of vertigo and acute hearing loss, usually in an infectious context (otitis).

• Trauma to the inner ear or vestibular concussion.

• Ototoxic medications (aminoglycosides, certain diuretics).

• Cholesteatoma, perilymphatic fistula.

Central Causes (rarer but serious)

• Stroke of the cerebellum or brainstem.

• Multiple sclerosis.

• Tumors (acoustic neuroma, brainstem tumor).

• Vestibular migraine.

• Encephalitis, meningitis.

Systemic and Other Causes

• Orthostatic hypotension, heart rhythm disorders, arrhythmias.

• Hypoglycemia, anemia, dehydration.

• Anxiety disorders, hyperventilation syndrome.

• Motion sickness.

• Sedative medications, antihypertensives, antiepileptics.

• Cervical involvement (rare as a unique cause).

Diagnosis of Vertigo

Diagnosis is based on medical history and clinical examination. Additional examinations are guided by the suspected cause.

Diagnostic Methods

• Detailed medical history: nature of vertigo, duration, onset circumstances, associated signs (auditory, neurological), medical history, medications.

• Clinical examination: search for nystagmus, provocative maneuvers (Dix-Hallpike maneuver for BPPV), Romberg test, neurological examination, ENT exam.

• Audiometry in case of auditory signs.

• Videonystagmography (VNG) to study nystagmus.

• Brain MRI in case of suspected central cause (vertigo with neurological signs, unusual vertigo, vascular context).

• Cardiovascular workup (ECG, Holter, echocardiography) in case of lightheadedness.

• Biological evaluation depending on the context.

Alternative Diagnoses

• Syncope or lightheadedness of cardiovascular origin.

• Stroke or TIA.

• Hypoglycemia, anemia, dehydration.

• Anxiety or panic attack.

• Seizure.

Treatment of Vertigo

Treatment depends on the identified cause.

BPPV

Effectively treated by repositioning maneuvers (Epley, Sémont) performed by the physician, ENT, or specialized physical therapist. Rapid disappearance of symptoms in the majority of cases. Recurrences are possible.

Ménière's Disease

• Low-salt diet, limitation of tobacco, caffeine, alcohol.

• Diuretics, long-term betahistine (Serc®).

• Acute attack treatment: antivertigo drugs, antiemetics.

• In case of failure: intratympanic injections, surgery.

Vestibular Neuritis and Labyrinthitis

• Initial rest, antivertigo drugs (betahistine, acetyl-leucine), antiemetics.

• Systemic corticosteroids at the onset of course.

• Antibiotics if infectious labyrinthitis.

• Antivirals in case of suspected viral origin (shingles).

• Early vestibular rehabilitation, essential to promote recovery.

Central Origin Vertigo

Treatment of the underlying cause (stroke, multiple sclerosis, tumor). Complementary vestibular rehabilitation.

Associated Measures

• Vestibular rehabilitation in physical therapy: essential in the majority of chronic vertigo cases.

• Prevention of falls in the elderly.

• Evaluation and adjustment of the offending medications.

• Management of associated anxiety disorders.

Prevention of Vertigo

• Balanced lifestyle: regular sleep, hydration, physical activity.

• Limitation of alcohol, tobacco and caffeine.

• Management of stress and anxiety disorders.

• Control of chronic diseases (hypertension, diabetes, heart rhythm disorders).

• Home adaptation in the elderly to limit falls.

• Regular review of treatments in the elderly subject.

• Preventive measures during travel (motion sickness medications if needed).

• Prompt consultation in case of recurrence or worsening.

Possible Complications

Vertigo, even benign, can lead to falls (with fractures, head traumas), a loss of autonomy, social isolation, anxiety and depressive disorders, a temporary contraindication to driving. Vertigo of central origin presents risks of severe neurological complications (stroke, sequelae). Ménière's disease can lead to progressive hearing loss.

When to Contact a Doctor for Vertigo

Any unusual, persistent, or disabling vertigo justifies a medical opinion:

• First-line: contact your treating physician, who can perform the initial exam, identify appropriate maneuvers (BPPV), or refer to an ENT or neurologist.

• If your treating physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of severity signs (neurological deficit, speech difficulties, sudden headache, loss of consciousness, chest pain), call 144 without delay.

Conclusion: characterizing vertigo to treat it better

Vertigo is a frequent reason for consultation, most often benign. It is characterized by a false sensation of movement, often associated with nausea, auditory disturbances, or a nystagmus, which can lead to complications such as falls, loss of autonomy, or reveal a serious neurological condition (stroke). Diagnosis is based on a precise analysis of symptoms and a careful clinical exam. Repositioning maneuvers and vestibular rehabilitation are remarkably effective in most vertigo cases of peripheral origin.

If in doubt, first ask your treating physician. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation. In case of neurological signs, do not hesitate: 144.