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Vertigo is a specific symptom often described as spinning, swaying, or feeling unsteady, as though you or the world around you is moving when in fact it.
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Vertigo is a specific symptom often described as spinning, swaying, or feeling unsteady, as though you or the world around you is moving when in fact it is not. It is fundamentally a neurological symptom, not a standalone diagnosis, and it frequently points to underlying dysfunction in the vestibular system (the inner ear balance apparatus), the brainstem, or the cerebellum.
It is important to distinguish vertigo from general dizziness or lightheadedness. True vertigo has a distinct rotational or motion quality and is typically caused by a specific, identifiable neurological or inner-ear condition. Accurately characterizing the type of dizziness you experience is critical to arriving at the correct diagnosis and treatment.
Vertigo can arise from a variety of conditions, broadly categorized as peripheral (inner-ear origin) or central (brain/brainstem origin):
BPPV is the most common cause of vertigo. It occurs when small calcium carbonate crystals (otoconia) become dislodged from their normal position in the inner ear and migrate into the semicircular canals, where they interfere with fluid movement and trigger false signals of rotation. BPPV is characteristically triggered by changes in head position, such as rolling over in bed, looking up, or bending forward, and produces brief, intense spinning episodes lasting seconds to a minute.
Vestibular migraine is increasingly recognized as a common cause of recurrent vertigo, particularly in patients with a personal or family history of migraine. Episodes involve spinning or imbalance accompanied by headache, light sensitivity, sound sensitivity, and nausea. Vestibular migraine can occur with or without a classic headache, making diagnosis challenging without specialized neurological evaluation.
Meniere’s disease is characterized by recurrent episodes of severe vertigo lasting 20 minutes to several hours, accompanied by fluctuating hearing loss, tinnitus (ringing in the ears), and a sense of fullness in the affected ear. It results from abnormal fluid accumulation (endolymphatic hydrops) in the inner ear and typically affects one ear, though bilateral involvement can occur over time.
Vestibular neuritis involves inflammation of the vestibular nerve, usually following a viral infection. It causes sudden-onset, severe vertigo that persists for days and then gradually improves over weeks. Labyrinthitis is similar but also involves hearing loss, indicating that the cochlea (hearing organ) is also inflamed. These conditions can leave patients with chronic imbalance and motion sensitivity during the recovery period.
Central vertigo originates from pathology within the brain, particularly the brainstem or cerebellum. Causes include stroke, transient ischemic attack (TIA), multiple sclerosis, and posterior fossa tumors. Central vertigo is often accompanied by other neurological symptoms such as double vision, difficulty swallowing, facial numbness, arm or leg weakness, or severe gait instability. These “red flag” symptoms warrant urgent neurological evaluation.
A thorough, systematic evaluation is essential to distinguish the many causes of vertigo. At Charis Neurology, our diagnostic approach includes:
Treatment is highly individualized based on the underlying cause:
You should consult a neurologist promptly if your vertigo:
Sudden-onset severe vertigo with any of these accompanying symptoms may represent a stroke or TIA and requires emergency evaluation.
If you are experiencing recurrent or persistent vertigo, contact Charis Neurology at (407) 603-1633 to schedule a neurological evaluation. Our team will work to identify the precise cause of your symptoms and develop a targeted treatment plan to help you regain stability and confidence.
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