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Dx Vertigo Treatment :


The Merck Manual Home Edition
"Dizziness is an inexact term people often use to describe various related sensations, including
*Faintness (feeling about to pass out)
*Feeling off balance or unsteady
*A vague spaced-out or swimmy-headed feeling

For dizziness that occurs only on standing up, see Dizziness or Light-Headedness When Standing Up [Orthostatic hypotension].

Vertigo is
*A false sensation of movement
With vertigo, people usually feel that they, their environment, or both are spinning. The feeling is similar to that produced by the childhood game of spinning round and round, then suddenly stopping and feeling the surroundings spin. Occasionally, people simply feel pulled to one side. Vertigo is not a diagnosis—it is a description of a sensation. People with dizziness or vertigo may also have nausea and vomiting, difficulty with balance, and/or trouble walking. Some people have a rhythmic jerking movement of the eyes (nystagmus) during an episode of vertigo.

Different people often use the terms “dizziness” and “vertigo” differently, perhaps because these sensations are hard to describe in words. Also, people may describe their sensations differently at different times. For example, the sensations might feel like light-headedness one time and like vertigo the next. Because of this inconsistency, many doctors prefer to consider the two symptoms together.

However they are described, dizziness and vertigo can be disturbing and even incapacitating, particularly when accompanied by nausea and vomiting. Symptoms cause particular problems for people doing an exacting or dangerous task, such as driving, flying, or operating heavy machinery.

Dizziness accounts for about 5 to 6% of doctor visits. It may occur at any age but becomes more common as people age. It affects about 40% of people older than 40 at some time. Dizziness may be temporary or chronic. Dizziness is considered chronic if it lasts more than a month. Chronic dizziness is more common among older people.
*About 95% of the time, dizziness, even if incapacitating, does not result from a serious disorder.
*In older people, dizziness often does not have a single, obvious cause.

Dizziness and vertigo are usually caused by disorders of the parts of the ear and brain that are involved in maintaining balance:
*Inner ear (see Inner Ear)
*Brain stem and cerebellum
*Nerve tracts connecting the brain stem and cerebellum or within the brain stem

The inner ear contains structures (the semicircular canals, saccule, and utricle) that enable the body to sense position and motion. Information from these structures is sent to the brain through the vestibulocochlear nerve (8th cranial nerve, which is also involved in hearing). This information is processed in the brain stem, which adjusts posture, and the cerebellum, which coordinates movements, to provide a sense of balance. A disorder in any of these structures can cause dizziness, vertigo, or both. Disorders of the inner ear sometimes also cause decreased hearing and/or ringing in the ear (tinnitus—see see Ear Ringing or Buzzing).

Also, any disorder that affects brain function in general (for example, low blood sugar, low blood pressure, severe anemia, or many drugs) can make people feel dizzy. Although symptoms may be disturbing and even incapacitating, only about 5% of cases result from a serious disorder.

Common causes:
Although there is some overlap, causes can roughly be divided into those with and without vertigo.

The most common causes of dizziness with vertigo include the following:
*Benign paroxysmal positional vertigo
*Meniere disease
*Vestibular neuronitis
*Vestibular migraine headache

Vestibular migraine headache is an increasingly common cause of dizziness with vertigo. This type of migraine (see Migraines) most often occurs in people who have a history or family history of migraines. People often have headache with the vertigo or dizziness. Some have other migraine-like symptoms, such as seeing flashing lights, having temporary blind spots, or being very sensitive to light and sound. People may also have hearing loss, but it is not a common symptom.

The most common causes of dizziness without vertigo include the following:
*Drug effects
*Multifactorial causes

Several kinds of drugs can cause dizziness. Some drugs are directly toxic to the nerves of the ears and/or balance organs (ototoxic drugs). Other drugs, for example, sedatives, affect the brain as a whole. In older people, dizziness often is due to several factors, usually a combination of drug side effects plus an age-related decrease in sensory function.

Very often, no particular cause is found, and symptoms go away without treatment.

Medications Used in Treatment:
1. Antiemetics: Antivert®/meclizine

Suggested Links:
*N.H.S. Choices

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