Dizziness & Vertigo

"Dizziness" is a non specific term that is often used to describe a variety of different symptoms. People who complain about "feeling dizzy" may refer to transient or persistent imbalance, lightheadedness or presyncope, etc. On the other hand, "vertigo" is a specific symptom that refers to the subjective illusion of a spinning or whirling motion - either the patient or the environment appear to be moving.

In the majority of cases, vertigo appears abruptly, has a short duration and is triggered by changes in the position of the head. It is an unpleasant experience, frequently accompanied by imbalance, nausea, sweating and occasionally anxiety. Recurrent and persistent episodes of vertigo can have a significant impact on the quality of life.

The causes of genuine vertigo are related to lesions either in the vestibular system (the “labyrinth” of the inner ear) or the structures of the central nervous system that are connected to the inner ear. In the former case, vertigo is categorized as “peripheral” whereas in the latter as “central”.

Vertigo of peripheral origin constitutes the majority of cases and is not life-threatening. Sometimes, it is accompanied by tinnitus, a sense of fullness in the ear or hearing loss. By far the most common cause of peripheral vertigo is BPPV (benign paroxysmal peripheral vertigo).

Central vertigo, although less frequent, may be caused by serious underlying conditions. As a general rule, every vertigo or dizziness that is accompanied by additional neurological symptoms should be immediately evaluated by a neurologist, particularly if there have been no episodes in the past. Accompanying symptoms that should raise concern are the following:

• New type of headache
• Difficulty speaking or hoarseness
• Numbness, especially if it appears on half of the face or body
• Eyelid droop (one sided)
• Difficulty or inability to walk
• Double vision
• Facial droop
• Loss of consciousness