Vertigo (cont.)
In this Article
Multiple sclerosis
Multiple sclerosis (MS) is a demyelinating (loss of nerve cell insulation)
brain disorder of unknown cause. MS usually follows a course of alternating
improved symptoms (remissions) and worsening symptoms (exacerbations). Although
vertigo or dizziness is not often the only indication of multiple sclerosis, it
is a common symptom that occurs at some point in the illness. Thus, vertigo is
the initial symptom in about 5% of patients, but is reported at some time during
the disease by as many as 50%. In addition, hearing loss occurs in about 10% of
patients. The diagnosis of MS is suggested when a young adult has a history of
multiple neurological abnormalities (e.g., visual disturbance, muscle weakness,
speech impediment, and mental changes) characterized by remissions and
exacerbations.
Disequilibrium of aging
As individuals age, there is a general decrease in vestibular function. This
decrease is accompanied by a general decrease in vision, position
(proprioception) sense, muscle and bone strength, and brain function. All of
these changes combined often lead to a slowly progressive feeling of imbalance
(disequilibrium). Nevertheless, these changes may be compensated in large part
by visual input. Consequently, elderly patients may notice more balance problems
at night. A general physical examination is important to rule-out other serious
conditions such as tumors or stroke that can cause balance problems.
Finally, a particular set of symptoms -- dizziness, unsteady walking,
increased frequency of urination, and forgetfulness -- may occur in elderly
patients due to a condition called a communicating hydrocephalus. In this
condition, a subtle accumulation of cerebrospinal fluid occurs in the brain due
to a failure of absorption of the fluid. There is no obstruction (blockage) of
the cerebrospinal fluid and the pressure of the fluid is normal. Nevertheless,
creating a shunt for drainage of the excess fluid can improve the symptoms.
- Dizziness is defined as a feeling of being woozy, drunk, unsteady, or
giddy. It is a general term used to describe the sensation of imbalance.
- Vertigo refers to an hallucination of motion, and is often described as a
spinning sensation. It usually implies a disorder of the inner ear.
- Lightheadedness indicates the sensation that occurs prior to fainting. It
is caused by a momentary decrease in blood flow to the brain.
- Motion sickness is a normal response to an abnormal situation when there
is conflicting information going to the brain from the eyes and the inner ear.
- Diseases that affect the eyes, ears, general sensory system (skin, muscle,
and joints), and the brain can cause balance problems.
- A patient's description of a balance problem is often the key to the
clinical diagnosis. Particularly helpful factors are the duration of the attack
and any triggering events.
- Special tests of balance function, hearing tests, CAT scan, and MRI scan
are often done to help make the diagnosis of a balance disorder. Referral to an
ear specialist or neurologist may be necessary.
- Patients with balance problems need to take proper precautions to avoid
accidents that could be caused by their balance disorder.
- Vestibular rehabilitation involves special exercises to help a patient
with a balance disorder adjust (accommodate) to the balance problem so as to
diminish recurrent symptoms.
- Common conditions causing balance problems include Meniere disease, motion
sickness syndrome, vestibular migraines, inner ear trauma, perilymphatic
fistula, medication damage to inner ear (ototoxicity), acoustic neuromas and
other brain tumors, benign paroxysmal positional vertigo, vertebral basilar
insufficiency, bacterial labyrinthitis, viral labyrinthitis (vestibular
neuronitis), multiple sclerosis, and disequilibrium of aging.
Last Editorial Review: 6/7/2005
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