“Dizziness with the sensation of movement (spinning) while stationary”

Risk Factors
  • Older age
  • History of vertigo
  • Female sex
  • Recent head injury
  • Certain medications (e.g. antidepressants, antipsychotics)
Aetiology
  • Peripheral vertigo:
    • BPPV
    • Head injury
    • Labyrinthitis
    • Vestibular neuronitis
    • Meniere’s disease
  • Central vertigo
  • Brain tumours
  • Migraine
  • MS
  • Stroke / TIA
  • Intoxication
Pathophysiology
  • Disturbance of the vestibular system, semi-circular canals or the vestibulocochlear nerve leads to the sensation of vertigo and associated symptoms.
  • This could be caused by damage to one of these organs or inappropriate neuronal input
Clinical Presentation
  • The patient will complain of a spinning sensation whilst standing, lying or sitting still
  • It may be provoked by specific movements
  • May be associated with nausea, vomiting, sweating, diplopia, headache, postural instability
Investigations
  • Dix Hallpike test: to diagnose BPPV
  • Audiometry / Rinne’s and Weber’s tests to investigate cases with tinnitus/hearing loss
  • Caloric testing
  • Videonystagmography/electronystagmography
  • Imaging (MRI/CT) to investigate suspected tumours, e.g. acoustic neuroma
Management
  • Some cases are self-limiting
  • Treat the underlying cause (e.g. Epley manoeuvre to treat BPPV, antibiotics to treat labyrinthitis)
  • Medical management (e.g. prochlorperazine, cyclizine, betahistine)
  • Vestibular rehabilitation training (VRT
Complications
  • Falls / injury due to dizziness, car accidents, long term consequences of the underlying cause, social isolation and depression

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