Unraveling the Mysteries of Vertigo: Exploring Causes, Symptoms, and Treatments

Host: Hello and Welcome to PACE Hospitals Podcast. Today, we're about to embark on a journey through the dizzying depths of vertigo.

Joining us today Dr. Sandhya Manorenj - Senior Consultant Neurologist having wide expertise in treating and managing Vertigo. In today’s episode she would like to unravel the complexities of this intriguing phenomenon and uncover its effects on our perception and daily lives.

Dr Sandhya Manorenj thank you for joining us at PACE Hospitals, Hitech City.

Doctor: Thank you for inviting me today, I would like to navigate through the dizzying array of causes, treatments, and coping strategies, offering insights that shed light on this dizzying phenomenon.

Host: Dr Sandhya Manorenj thank you for joining us lets understand exactly 

Host: what is vertigo and dizziness?

Doctor: As we know, in our lifetime, someone might be affected with dizziness or vertigo. So let's know knowledge about vertigo or dizziness. Now, coming to what is Vertigo? Vertigo is a sense of false motion, self-motion. Even though there is no self-motion that is vertigo. It is closely resembled to dizziness also, where the person doesn't have any self-motion, but they will have some spatial disorientation.

So a person with vertigo can also have dizziness initially and then later on. Vertigo. Dizziness is a feeling of disturbed spatial orientation, but there is no self-motion. So these are closer related terms in a patient with vestibular symptoms.

Host: What are the types and causes of vertigo?

Doctor: There are two types of vertigo, central vertigo and peripheral vertigo. Central vertigo means central causes of the brain, that is, there are certain structures in the brain which can produce vertigo, and they are the brain steps.

Cerebellum and sometimes large space occupying lesion can also produce central vertigo and sometimes certain patients with vestibular migraine is also a central cause of vertebra. Now, coming to the peripheral vertebral, the word peripheral itself indicates that whenever any peripheral structures of the brain, that is, which is important to balance control, that is, the ear related structures, it can be labyrinthitis, or it can be vestibular neuritis, or it can be related to the bony canal, semi-circular canal, that is benign positional vertigo, all can produce peripheral vertigo.

There are certain other causes of vertigo related to the neck, that is, we commonly see, that is, cervical genic vertigo or cervical genic dizziness. There are variety of other causes that also can produce peripheral vertigo.

Host: What are the symptoms of vestibular vertigo?

Doctor: We see in the patient with vertigo, they can have vertigo, they can have dizziness, or they can have certain visual symptoms, such as visual illusions that they can see. The images are tilted, some images are far, when they turn to the head in. 

Sometimes they may also have postal symptoms, that is, whenever they get up from the sitting position or whenever they get up from the lying position, they stand, they feel a reeling sensation that are the postal symptoms, so the patient can have vertigo diagnosis and postal symptoms and they will feel that someone is pulling them to one side, that is called pulsion, directional pulsion, so these are the symptoms.

Some patients can have history of ear block, that is tinnitus, ringing in the ear, or they can feel ear fullness, or they can have ear pain, or they can have deafness. These are the other symptoms associated with vertigo. Sometimes they can also have headache.

Host: What are the complications of vertigo?

Doctor: If the person has suddenly vertigo, what will happen if it is not controlled, person will fall and then they will have head injury. Suddenly they will fall in the bathroom, they will fall in the roadside or while driving vertigo, they cannot see, they will feel a sense of false motion, so they can lead to accidents, so these are the complications of the vertigo.

Host: So, doctor, can you tell me about the risk factors of vertigo?

Doctor: So, usually the studies have found that people with middle age, that is between 50 to 70 years, can have vertigo they are higher risk for vertigo and especially the females are also having higher risk group for vertigo and especially these all people will have more of a peripheral vertigo, but ladies will have other than peripheral that is central causes of vertebra.

Host: What are the diagnostic tests for vertigo?

Doctor: First and most important is there are tests to know the actual etiology of the vertigo so whether it is central and peripheral. So first, the person should be evaluated in detail it includes both clinical examination and certain test.

So your doctor will examine you for the test, so clinical test, bedside, they will do, that is head impulse test. Your doctor will suddenly turn your head to either side, right side and left side. And then they will see the eye movements, some nystagmus, some jerky moments will be seen in the eyes and they will pick up whether it is ear related to vertebra or it is due to central vertebra.

Sometime a person, the eye will be directed to the one side, that is q deviation. We tell in scientific terms, that indicates that central cause of vertigo. So head impulses, your doctor will do and in cases of what we most commonly see is benign paroxysmal positional vertigo that is due to the autolith in the semi-circular canal that can also produce vertigo.

So your doctor, in the clinical, in the OPD side, they will do one manure that is called Dix hallpack manure what happened in Dix all pack manure. Suddenly the person is made to sleep and then made to lie and in the head down position at the 20 degree, both right side and left side, at a 45 degree and at that position, the person will have severe vertigo. So this is another method to confirm benign Paroxysmal positional vertigo.

Sometime your doctor may ask for ENT evaluation thorough to see any ear related cause is there any ear block, is there any deafness is there, So in that part of the workup is the pure tone audiometry at the test other test. If the doctor feels that there is central cause of vertigo, then MRA brain is needed.

Host: What are the treatment options for vertigo?

Doctor: So, treatment of the vertigo depends upon the etiology of treatment. Most common, we see benign paroxysmal positional vertigo, that is, semi-circular canal involvement. So in that if the patient person, the physician decides that it is confirmed, PPV is confirmed by big hallpack manure, then the bedside itself, the doctor will do one manure it is called epilepsy manure.

This manure can be done by both neurologists or neurologists or even ENT surgeon who are specialized in dealing with vertigo, will do this manure and immediately the vertigo will be corrected at that instant itself.

For older people, they may recover three or four times this epilepsy manure has to be done and then this is the management for benign paroxysmal positional vertebra. But we should know there are various other causes of vertebra.

For example, in patient with migraine. Migraine is a condition vestibular migraine. The person will have migraine with vertebra, so we need to treat that and sometimes most common we see in older people, they will have orthostatic intolerance, their vertigo or dizziness.

The reason is because of low BP, whenever they are standing at that time, BP is down and they feel dizzy or vertigo, so you need to consult the cardiologist at that time and your blood pressure medicine to be adjusted. Commonly in females, we see young females, anemia is a cause of dizziness, so treatment depends upon the etiology of the vertebra.

Host:How to prevent the vertigo?

Doctor: Prevention of vertigo, it depends upon again etiology. For example, a person is having vestibular migraine. We need to avoid the migraine triggers. There are various migraine triggers like sunlight exposure, certain foods or sound, phonophobia, photophobia all that has to be avoided. It changed from person to person that is, migrant triggers should be avoided and for that purpose they should have definite prophylactic medicine should be given.

In case of benign paroxysmal positional vertigo, the person should continue the exercises. Rehabilitation exercise which your doctor will tell you. The name of that exercise is branded Darov's vestibular rehabilitation exercise. So person need to continue to strengthen the vestibular apparatus that is the one method.

And second, anti-vertigo drugs will also help and in certain cases, your doctor may ask you to the fasting lipid profiles. If the cholesterol is high, there is high chance of producing autofill formation and benign Paroxysmal positional vertigo.

And the other causes. If the person has acute onset of vertigo, for example, in a scenario of an older male, 50 or 60 years, sudden onset of acute vertigo and with blurring of vision, diplopia or any weakness. First possibility we need to construct is brainstorm stroke. Stroke has to be managed according to whether it is decreased blood supply or it is blood blades like that it will go, and there are other causes of vertebral triggers we should avoid that is in case of semicircular canal dehesance.

That is the one antidrug where a person will have trigger of vertigo after a loud sound, so we need to avoid loud sound. Such cases. So that are the certain triggers which we need to prevent.

For example, young female recurrent dizziness they are getting and they are not drinking water. Hypertension is also cause of dizziness, so dehydration We need to advise them dehydration and we commonly seen is cervical genic dizziness.

In older age group, they will come with history of neck pain and then they will complete vertigo. If we miss that neck pain, we are not able to control the vertigo. So neck treatment, muscle relaxant, calcium related drugs and in such case we need to do MRA cervical spine. Sometimes last triggers are the psychogenic, even psychogenic anxiety.

Stress also can provoke vertigo or disease in certain cases. So they need behavioral therapy, cognitive behavioral therapy, reassurance.

Host: So, doctor, is vertigo dangerous?

Doctor: See vertigo, it depends upon the etiology. For example, it is a risky. It is a dangerous condition because it can take the life dangerous. In other scenarios, if the patient is on the way and sudden vertigo is falling, he is having a head injury.

If a patient have traumatic brain injury, subdural hematoma then it becomes dangerous. As such, it is not a dangerous condition. In certain scenario it is dangerous.

Host: Is vertigo hereditary?

Doctor; See vertigo, usually it is not considered as hereditary, but the vertigo can be the associated symptom of certain hereditary syndromes, like vestibular migraine. Migraine is a genetic disorder,

so then we can tell it is a hereditary work and there are certain episodic ataxia. They are all hereditary syndrome where episodic ataxia, the person will have suddenly vertigo, imbalance and then fall. It is a genetic condition.

Host: Is vertigo curable?

Doctor: Yes, vertigo is mostly. It is curable condition, depending upon the etiology.

Host: How long does vertigo last?

Doctor: See vertigo, it depends upon the type of the vertigo. For example, the list of the duration of vertigo is we term in scientific is Vestibular paroxysmia. Vestibular paroxysmia is a condition where in the brain, one artery is there, around that artery, the artery will rotate around the vestibular nerve that is Vestibular paroxysmia.

There, the person will have multiple episodes of vertigo, but it will last for seconds, usually seen in females, so that is exclusion of all other causes of vertigos. Shortest occurring and in Benign paroxysmal positional vertigo, the duration of vertigo is only 1 minute. So duration of vertigo will help a neurologist or a clinician to diagnose the type of vertigo.

In case of vestibular migraine, it will last for five minutes to even 72 hours. Vestibular migraine vertigo can occur from five minutes to 72 hours and in case of menus disease. Menus disease. The patient will have sudden tentonitus of the ear, and then they will also feel fullness of the ear and after the attack, they will have hearing loss.

In such cases, the vertigo will last 20 minutes, 12 hours. Then one entity is their psychogenic vertigo. In such people, they will have chronic vertigo. Long standing, it can last for weeks or months and in case of central vertigo that is secondary to the brainstem causes, that is stroke, cerebellar stroke, even they will have long standing vertigo, like it can last three months.

Host: Can stress cause vertigo?

Doctor: Yes, stress, anxiety, even depression can cause vertigo.

Host: Can high blood pressure cause vertigo?

Doctor: Yes, high blood pressure can also cause vertigo because it can produce stroke. Even the blood pressure, even high and low blood pressure, both can produce vertigo, high blood pressure in terms of increased perfusion, or they can produce stroke or brainstorm bleed, they can produce vertigo and in patients with low BP, even can produce vertigo and dizziness, especially on standing.

So such cases, patients will clearly tell that they feel dizzy and vertigo when they are standing, but they won't have any dizziness and vertigo when they are lying.

Host: Can dehydration cause vertigo?

Doctor: Yes. Dehydration can also cause vertigo, dehydration will cause hypotension, decreased intake of the fluids in the body, hypotension, so decreased blood supply to the brain and patient will have dizziness, they will have more of a dizziness i.e., spatial disorientation feeling. It will have rather than clear cut vertigo, self motion.

Host: Can migraines cause vertigo?

Doctor: Migraine can cause vertigo i.e., vestibular migraine. A form of migraine, it is called migraine with vertigo can cause vertigo.

Host: Can thyroid cause vertigo?

Doctor: Thyroid can cause vertigo both hypothyroidism and hyperthyroidism can cause vertigo. Hypothyroidism means there is low thyroid level. So whenever there is low thyroid, your heartbeat will be reduced.

So person will have Brady cardia, so decreased blood supply, decreased heart rate. Then patient can have dizziness. Hyperthyroidism means increased heart rate, palpitation and again, person can have dizziness.

Host: What are the triggers of vertigo?

Doctor: The triggers of the vertigo that is in patients with vestibular migraine, migraine triggers will produce vertigo. In case of Benign paroxysmal positional vertigo i.e., turning of the head, sudden turning of the head, rotation of the head on the either side, rolling in the bed, suddenly looking down, suddenly looking up can produce vertigo and in case of loud sound, in certain condition like semi-circular canal dehesance, loud sound can produce vertigo and in case of orthostatic intolerance, that is dizziness due to orthostatic BP is down at that time person, when they are standing, they will have dizziness, so these are the triggers of vertigo.

Host: Can vertigo go away on its own?

Doctor: Usually vertigo doesn't go away by its own, it needs treatment either epilepsy manual depending upon the cause or vestibular migraine, that patients should be on continuous prophylactic medicines, but in certain scenario like that benign paroxysmal positional vertigo where the horizontal semi-circular canal is affected. The person can have short lasting vertigo and it is self remitting. It is the only one condition where it will go by itself.

Host: How to cure cervical vertigo?

Doctor: Cervical vertigo means the vertigo secondary to cervical spondylosis. In cervical spondylosis there is muscle spasm, prolapse, disc, so muscle tightness will be there that itself will produce dizziness and vertigo such cases we need to give the patient short course of analgesic muscle relaxant, neurologic drug and in addition to that cervical tongue turning exercise should be advised, and we need to also check in such cases whether the vertebral artery is affected or not.

Because one artery is there, we supply the brain, which go through the neck region. So for that Doppler necessary has to be done.

Thank you Dr Sandhya Manorenj for sharing crucial information regarding the vertigo to our listeners.

I hope this information can be valuable for the listeners that, understanding this condition empowers us to conquer its challenges and embrace a balanced life.

If any of you have any further questions regarding vertigo please don’t hesitate to consult a neurologist and remember, as we explore the depths of vertigo, may you find balance and clarity in both your inner and outer worlds.

We will be back soon with another episode on PACE Hospitals Podcast, until next time, take care and stay grounded. Thank you.