VERTIGO

Vertigo Definition

• Vertigo is a false sensation of spinning or whirling.

Types

• Peripheral vertigo (BPPV, Labyrinthitis, Ménière's disease)
• Central vertigo (Stroke, Tumor, Infection)

Pathology

• Peripheral vertigo: Benign Paroxysmal Positional Vertigo (BPPV) - otoconial debris in the semicircular canals, Labyrinthitis - inflammation of the inner ear, Ménière's disease - inner ear disorder.
• Central vertigo: Stroke - thrombosis or embolism, Tumor - space-occupying lesion, Infection - encephalitis or meningitis.

Blood Supply

• The labyrinth is supplied by the anterior inferior cerebellar artery (AICA) and the labyrinthine artery.

Nerve Supply

• The labyrinth is innervated by the vestibulocochlear nerve (CN VIII).

Clinical Anatomy

• The vestibular system includes the semicircular canals, otolith organs (utricle and saccule), and the vestibular nerve.
• The cochlear system includes the cochlear duct, the basilar membrane, and the cochlear nerve.

Causes

• Peripheral vertigo: BPPV, Labyrinthitis, Ménière's disease, Vestibular neuritis.
• Central vertigo: Stroke, Tumor, Infection, Multiple sclerosis.

Clinical Features

• Peripheral vertigo: Sudden onset, spinning sensation, nausea, vomiting, and imbalance.
• Central vertigo: Sudden onset, confusion, weakness, difficulty speaking, and double vision.

Complications

• Peripheral vertigo: Dehydration, hearing loss, tinnitus, and dizziness.
• Central vertigo: Stroke, paralysis, aphasia, and death.

Investigations

• History and physical examination.
• Caloric test - tests the vestibular system.
• Electronystagmography (ENG) - measures eye movements.
• Auditory brainstem response (ABR) - tests the cochlear nerve.
• Computed tomography (CT) scan and magnetic resonance imaging (MRI) - tests for central causes.

Management

• Peripheral vertigo: Treatment includes lifestyle modifications, vestibular rehabilitation therapy, and medication.
• Central vertigo: Treatment includes medication, surgery, and rehabilitation.

Treatment

• Peripheral vertigo: Vestibular suppressants, vestibular rehab therapy, and lifestyle modifications.
• Central vertigo: Medication, surgery, and rehabilitation.

Homoeopathic Remedies

• For peripheral vertigo:
  • Aconite: Headache, nausea, and vomiting.
  • Belladonna: Sudden onset of vertigo, headache, and fever.
  • Bryonia: Vertigo, headache, and nausea.
  • Cocculus: Dizziness, nausea, and vomiting.
  • Conium: Vertigo, weakness, and numbness.
  • Lachesis: Vertigo, headache, and nausea.
  • Nux vomica: Vertigo, headache, and nausea.
  • Pulsatilla: Vertigo, headache, and nausea.
  • Sepia: Vertigo, weakness, and numbness.
  • Veratrum album: Vertigo, headache, and nausea.
• For central vertigo:
  • Apis: Stroke, paralysis, and aphasia.
  • Belladonna: Sudden onset of vertigo, headache, and fever.
  • Bryonia: Vertigo, headache, and nausea.
  • Conium: Vertigo, weakness, and numbness.
  • Lachesis: Vertigo, headache, and nausea.
  • Nux vomica: Vertigo, headache, and nausea.
  • • Phosphorus: Stroke, paralysis, and aphasia.
  • Pulsatilla: Vertigo, headache, and nausea.
  • Sepia: Vertigo, weakness, and numbness.
  • Veratrum album: Vertigo, headache, and nausea.

Examination of a Vertigo Case 1 → Symptoms and history are recorded. 2 → A physical examination is performed. 3 → A caloric test is done. 4 → Electronystagmography (ENG) is performed. 5 → Imaging studies (CT scan and MRI) are done. 6 → The results of the investigations are interpreted. 7 → A diagnosis is made. 8 → A treatment plan is created. 9 → The patient is followed up to assess the effectiveness of the treatment.