Vertigo

All Music Guide:

Vertigo combine big punk guitars with a psychedelic '60s sound. Comprised of drummer Bill Beeman and guitarists/bassists/vocalists Gene Tangren and Jared Aos, the Minneapolis-based band have recorded three albums for Amphetamine Reptile.

Wikipedia:

Vertigo /ˈvɜː(ɹ)tɨɡoʊ/ (from the Latin vertō "a whirling or spinning movement") is a subtype of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to an asymmetric dysfunction of the vestibular system in the inner ear. It is often associated with nausea and vomiting as well as a balance disorder, causing difficulties standing or walking. There are three types of vertigo: (1) Objective− the patient has the sensation that objects in the environment are moving; (2) Subjective− patient feels as if he or she is moving; (3)Pseudovertigo− intensive sensation of rotation inside the patient's head.

Dizziness and vertigo rank among the most common complaints in medicine, affecting approximately 20%-30% of the general population. Vertigo may be present in patients of all ages. However, it is rarely a primary concern amongst children, and becomes more prevalant with increasing age. The most common causes are benign paroxysmal positional vertigo, concussion and vestibular migraine while less common causes include Ménière's disease and vestibular neuritis. Excessive consumption of ethanol (alcoholic beverages) can also cause notorious symptoms of vertigo. (For more information see Short term effects of alcohol). Repetitive spinning, as in familiar childhood games, can induce short-lived vertigo by disrupting the inertia of the fluid in the vestibular system.

Classification

Vertigo is classified into either peripheral or central depending on the location of the dysfunction of the vestibular pathway, although it can also be caused by psychological factors.

Peripheral

Vertigo caused by problems with the inner ear or vestibular system, which is composed of the semicircular canals, the otolith (utricle and saccule), and the vestibular nerve is called "peripheral", "otologic" or "vestibular" vertigo. The most common cause is benign paroxysmal positional vertigo (BPPV), which accounts for 32% of all peripheral vertigo. Other causes include Ménière's disease (12%), superior canal dehiscence syndrome, labyrinthitis and visual vertigo. Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient vertigo if they involve the inner ear, as may chemical insults (e.g., aminoglycosides) or physical trauma (e.g., skull fractures). Motion sickness is sometimes classified as a cause of peripheral vertigo.

Patients with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, fullness, and pain in the ear. In addition, lesions of the internal auditory canal may be associated with ipsilateral fascial weakness. Due to a rapid compensation process, acute vertigo as a result of a peripheral lesion tends to improve in a short period of time (days to weeks).

Central

Vertigo that arises from injury to the balance centers of the central nervous system (CNS), is generally associated with less prominent movement illusion and nausea than vertigo of peripheral origin. Central vertigo has accompanying neurologic deficits (such as slurred speech and double vision), and pathologic nystagmus (which is pure vertical/torsional). Central pathology can cause disequilibrium which is the sensation of being off-balance. The balance disorder associated with central lesions causing vertigo are often so severe that many patients are unable to stand or walk.

A number of conditions that involve the central nervous system may lead to vertigo including: lesions caused by infarctions or hemorrhage, tumor, epilepsy, cervical spine disorders, degeneration, migraine headaches, lateral medullary syndrome, multiple sclerosis, parkinsonism, as well as cerebral dysfunction. Central vertigo may not improve or may do so more slowly than vertigo caused by disturbance to peripheral structures.

Signs and symptoms

Vertigo is a sensation of spinning while stationary. It is commonly associated with vomiting or nausea, unsteadiness, and excessive perspiration. Recurrent episodes in those with vertigo are common and they frequently impair the quality of life.

Blurred vision, difficulty speaking, a lowered level of consciousness, and hearing loss may also occur. Central nervous system disorders may lead to permanent symptoms.

The signs and symptoms of vertigo can present as a persistent (insidious) onset or an episodic (sudden) onset..

The characteristics of persistent onset vertigo is indicated by symptoms lasting for longer than one day and caused by degenerative changes that affect balance as we age. Naturally, the nerve conduction slows with aging and a decreased vibratory sensation is common. Additionally, there is a degeneration of the ampulla and otolith organs with an increase in age. Persistent onset is commonly paired with central vertigo signs and systems.

The characteristics of an episodic onset vertigo is indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes. Typically, episodic vertigo is correlated with peripheral symptoms and can be the result of but not limited to diabetic neuropathy or autoimmune disease.

Differential diagnosis

A number of specific conditions can cause vertigo. In the elderly, however, the condition is often multifactorial.

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is brief periods of vertigo ( less than one minute ) which occur with change in position. It is the most common cause of vertigo. It occurs in 0.6% of the population yearly with 10% having an attack during their lifetime. It is believed to be due to a mechanical malfunction of the inner ear. BPPV can be effectively treated with repositioning movements.

Vestibular migraine

Vestibular migraine is the association of vertigo and migraines. It is the second most frequent cause of recurrent vertigo with a lifetime occurrence rate of about 1%.

Ménière's disease

Ménière's disease frequently presents with vertigo in combination with ringing in the ears, a feeling of pressure or fullness, severe nausea or vomiting, and hearing loss. As the disease worsens, hearing loss will progress.

Vestibular neuritis

Vestibular neuritis presents with severe vertigo. It is believed to be caused by a viral infection of the inner ear. Persisting balance problems may remain in 30% of people affected.

Motion sickness

Motion sickness is one of the biggest symptoms of vertigo and it develops most often in persons with inner ear problems. The feeling of dizziness and lightheadedness is often accompanied by nystagmus. This is when the eyes rapidly jerk to one side and then slowly find their way back to the original position. During a single episode of vertigo, this action will occur repeatedly. Symptoms can fade while sitting still with the eyes closed.

Pathophysiology

The neurochemistry of vertigo includes 6 primary neurotransmitters that have been identified between the 3-neuron arc that drives the vestibulo-ocular reflex (VOR). Many others play more minor roles.

Three neurotransmitters that work peripherally and centrally include glutamate, acetylcholine, and GABA.

Glutamate maintains the resting discharge of the central vestibular neurons, and may modulate synaptic transmission in all 3 neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. GABA is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells and the lateral vestibular nucleus, and the vertical VOR.

Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. It is known that centrally acting antihistamines modulate the symptoms of motion sickness.

The neurochemistry of emesis overlaps with the neurochemistry of motion sickness and vertigo. Acetylcholine, histamine, and dopamine are excitatory neurotransmitters, working centrally on the control of emesis. GABA inhibits central emesis reflexes. Serotonin is involved in central and peripheral control of emesis but has little influence on vertigo and motion sickness.

Diagnostic approach

BPPV is normally diagnosed with the Dix-Hallpike test . Tests of vestibular system (balance) function include electronystagmography (ENG), rotation tests, caloric reflex test, and computerized dynamic posturography (CDP).

Tests of auditory system (hearing) function include pure-tone audiometry, speech audiometry, acoustic-reflex, electrocochleography (ECoG), otoacoustic emissions (OAE), and auditory brainstem response test (ABR; also known as BER, BSER, or BAER).

Other diagnostic tests include magnetic resonance imaging (MRI) and computerized axial tomography (CAT or CT).

Treatment

Definitive treatment depends on the underlying cause of the vertigo.

Epidemiology

Vertigo is a frequent symptom in the general population with a 12-month prevalence of 5% and an incidence of 1.4% in adults. Its prevalence rises with age and is about two to three times higher in women than in men. It accounts for about 2-3 % of emergency department visits.