Vertigo: Pathology review

At the family medicine center, there’s a 55 year old female, named Juliette, who came to visit the doctor because she has had some episodes where she felt like “everything around her was moving”.

These episodes start abruptly and usually last a few hours.

She also complains of ringing in her left ear and feels that she can’t hear very well from that ear.

Her medical history is otherwise insignificant.

Clinical examination reveals horizontal nystagmus.

Next to Juliette, there’s a 70 year old male, named Alasdair, who is brought in by his son because an hour ago he felt that “the room around him was moving” and had difficulty in speaking.

He also complains of “seeing double”.

Alasdair has hyperlipidemia and hypertension.

Clinical examination reveals vertical nystagmus.

Alright, so both Juliette and Alasdair have vertigo.

People with vertigo will often say they get “dizzy,” which is an imprecise term.

What they are experiencing is either vertigo, syncope or presyncope, also known as lightheadedness, or disequilibrium.

The difference is vertigo can be thought of as having an illusion of self-motion, or movement of the surrounding environment; syncope is the feeling of blacking out or fainting; and disequilibrium causes a sensation of being off balance without the sensation of the environment moving.

Vertigo arises when there’s a mismatch between other sensory systems, like sight and proprioception, and the vestibular system.

The vestibular system is made of the vestibular apparatus; including the three semicircular canals, the utricle and saccule, the vestibular nerve, and the vestibular structures in the brainstem and cerebellum.

Vertigo can be broken down into peripheral vertigo, which is due to damage to the vestibular apparatus, or damage to the vestibular nerve, and central vertigo, which is due to damage to the vestibular structures in the brainstem or cerebellum.