In vertigo (vertigo) (synonyms: Motion vertigo; spinning sensation; spinning vertigo; lift vertigo; vertigo (vertigo); dizziness; ICD-10 R42: vertigo and staggering) is an important leading symptom that can occur in very many different diseases of different etiology (causes), which originate from the inner ear, brainstem or cerebellum, but can also have psychological causes. A classification of vertigo can be made according to:
Etiology (cause):
- Vestibular vertigo
- Benign paroxysmal positional vertigo * (BPLS; synonyms: cupulolithiasis; canalolithiasis and (abbreviated) benign positional vertigo (not to be confused with positional vertigo); benign paroxysmal positional vertigo (BPPV); benign peripheral paroxysmal positional vertigo (BPPV)) (incidence: 17.1%)
- Meniere’s disease * (frequency: 10.1%) (here: vestibular migraine; frequency: 11.4%).
- Neuritis vestibularis * (synonyms: vestibular neuritis, neuropathia vestibularis) (frequency: 8.3%).
- Bilateral vestibulopathy (BV) (frequency: 7.1%).
- Vestibular paroxysmia (incidence: 3.7%).
- Central vestibular disorders/syndromes (frequency: 12.3%).
- Non-vestibular vertigo
* In bold, the most common “peripheral-vestubular” disorders.
Type of vertigo
- Systematic vertigo (directional vertigo).
- Continuous vertigo
- Spinning dizziness
- Altitude vertigo
- Positional vertigo
- Paroxysmal positional vertigo (more commonly benign paroxysmal positional vertigo, less commonly central positional vertigo or positional ystagmus).
- Positional vertigo:
- Elevator vertigo
- Staggering vertigo (e.g. phobic staggering vertigo, frequency: 15%).
- Unsystematic vertigo (undirected vertigo, diffuse vertigo).
60% of dizziness can not be attributed causally to a disease – quite predominantly they disappear again. These include mainly:
- Psychogenic (phobic) vertigo (PPBS).
- Vertigo in old age: disturbances at different sites of balance perception and processing (usually disappear by adaptation).
Dizzy spells are the second most common leading symptom after headaches, not only in neurology. Gender ratio Benign paroxysmal positional vertigo: men to women 1: 2. Meniere’s disease: men are more often affected than women. However, study evidence is conflicting in many cases. Frequency peak: vertigo in general occurs more frequently with increasing age, especially in the group over 80 years. Benign peripheral paroxysmal positional vertigo may occur from childhood to senility. Neuritis vestibularis: The disease occurs predominantly between the ages of 30 and 60. Meniere’s disease: the disease occurs predominantly between the ages of 40 and 60. Non-cardiac vertigo: The disease occurs predominantly in those over 65 years of age. The prevalence (disease incidence) for vertigo in general is approximately one quarter of the population (in Germany). The prevalence can increase up to 40% in old age. The lifetime prevalence for moderate and severe dizziness is up to 30%. Over 65-year-olds suffer from dizziness at least once a month in about 30% of cases. The lifetime prevalence of Meniere’s disease is 0.5%. The lifetime prevalence of spinning and vertigo is approximately 30%. The prevalence for benign paroxysmal positional vertigo is 10% (in those over 80 years of age). The prevalence for non-cardiac vertigo is 20% (in those over 65 years of age). The incidence (frequency of new cases) for neuritis vestibularis (vestibular vertigo) is approximately 3.5 cases per 100,000 population per year (in Germany). Course and prognosis: attacks of vertigo are usually unexpected and may be accompanied by nausea (nausea) and vomiting (vomiting). Those affected usually feel helpless. In children, vertigo attacks are almost always harmless. In most cases, it is a pseudo-dizziness due to a lack of consciousness.orthostatic dysregulation (drop in blood pressure), hyperventilation (increased breathing beyond what is needed), or psychological problems (30-40% of cases). True vertigo (most likely a spinning vertigo) is extremely rare. Causes of true vertigo are CNS infections, middle ear disease, trauma with labyrinth damage (e.g., fall trauma with skull base fractures involving the petrous bone).In adults, the most common vertigo is benign paroxysmal positional vertigo (benign positional vertigo).In pregnant women, vertigo is usually due to a drop in blood pressure because of orthostatic dysregulation.In elderly patients, a multifactorial genesis of vertigo is more common. The prognosis of vertigo depends on the type and severity of the underlying disease. However, it usually takes some time to diagnose the underlying disease. For example, persistent vertigo usually indicates psychological triggers. Note: Dizziness is considered an independent risk parameter for mortality risk: The risk of death for dizziness patients was 70% higher than the risk of dizziness-free patients (OR 1.7). 9% of dizziness patients died in the following five years.Dizziness is the most common leading symptom in gait unsteadiness in the elderly (> 75 years) is.
