Vertigo, Not an Easy Diagnosis

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

The room spins wildly around, and you become intensely nauseous. No, it's a ride at your local amusement park, not the residual of an all night party, but instead, you are challenged with vertigo. The symptoms are highly unpleasant and incapacitating, and the illness has a variety of causes including:

  • trauma to the inner ear,
  • stroke, or
  • the most common cause, idiopathic, meaning we just don't know.

Balance is complicated. The labyrinth system (the inner ear, see diagram below) has a gyroscope mechanism that tells the brain where the body is in relation to the world. To be in tune with your surroundings, the gyroscope needs to work, and the brain needs to interpret the signals. The labyrinth can get confused (for example, from viral infections or repeated head movements - like using a computer to enter data or cleaning cupboards above your head), or - just because. The cerebellum (the back part of the brain), can misinterpret the signals (for example, due to a tumor or stroke), so vertigo is not a symptom to be taken lightly. Fortunately, with a detailed medical history and physical exam, the doctor should be able to distinguish loss of balance due to an inner ear problem - from incoordination resulting from a brain problem.