Vertigo
Cervical Vertigo
What is Cervical Vertigo?
Vertigo or dizziness occasionally accompanies a neck injury. The precise incidence is controversial. Nevertheless, cervical vertigo is matter of considerable concern because of the high litigation related costs of whiplash injuries.
When cervical vertigo symptoms is diagnosed, the usual symptoms are dizziness associated with neck movement. There should be no hearing symptoms or findings but there may be ear pain (otalgia). Brandt (1996) has recently reviewed this topic.
What Causes Cervical Vertigo Disorder?
Physiologically, there are two well recognized potential causes of cervical vertigo:
- Vascular compression. The vertebral arteries in the neck can be compressed by the vertebrae (which they traverse), or other structures. Arthritis, surgery, chiropractic manipulation are all possibilities. The most common cause of vertebral dissection is chiropractic manipulation (Vibert et al, ORL, 1993). For this reason, we recommend against chiropractic treatment of vertigo that includes "snapping" or forceful manipulation of the vertigo.
- Abnormal sensory input from neck proprioceptors. Sensory information from the neck may be unreliable or absent. Sensory information from the neck is combined with vestibular and visual information to determine the position of the head on the neck, and space. This mechanism was investigated by DeJong and DeJong who injected local anesthetics into their own necks. Such injections caused unsteadiness and minor amounts of dizziness. It is possible that some individuals are more sensitive than others, and also that neck inputs interact with other causes of vertigo.
How is Cervical Vertigo Diagnosed?
Diagnosis is generally uncertain and frustrating. First, other entities need to be ruled out including inner ear disease, central vertigo, psychogenic vertigo (often including malingering when there are legal issues), and medical causes of vertigo. There should be no hearing symptoms or findings, but there may be ear pain (otalgia), as part of the ear is supplied by sensory afferents from the high cervical nerve roots. As cervical vertigo often follows a head injury; in this situation, the various causes of post-traumatic vertigo shoud be considered.
If symptoms of vertigo still seems likely after excluding reasonable alternatives, one next needs to look for positive confirmation. The "gold standard test" for the vertebral arteries is vertebral angiography. Because this is a risky procedure by itself, often it is decided not to proceed to this step. Ordinary magnetic resonance angiography (MRA) and vertebral doppler procedures are rarely abnormal, and sometimes are used as a screening procedure to decide whether vertebral angiography is necessary. A magnetic resonance imaging (MRI) scan of the neck and flexion-extension X-ray films of the neck are suggested in all.
Many patients who have vertigo in the context of neck disease have a BPPV type nystagmus on positional testing. This suggests that the neck afferents may interact strongly with vestibular inputs derived from the posterior canal.
Epileptic Vertigo
What is Epileptic Vertigo?
While epilepsy is commonly accompanied by dizziness or vertigo, vertigo is only rarely caused by epilepsy. This arises primarily because vertigo is much more commonly caused by ear conditions. Epileptic vertigo is due to brain injury, typically the part of the temporal lobe that processes vestibular signals. Loss of consciousness usually occurs at the time of injury. The typical symptom is "quick spins," although this symptom has other potential causes (for example, BPPV or vestibular neuritis).
What Causes Epileptic Vertigo?
Epileptic vertigo symptom is felt to be caused by abnormal stimulation of parts of the cortex that represent the vestibular system -- parietal, temporal and frontal cortex. Specific areas include the superior lip of the intraparietal sulcus, the posterior superior temporal lobe, and the temporal-parietal border regions (Penfield, 1954)
How is Epileptic Vertigo Diagnosed?
Epileptic vertigo is only a diagnostic problem when the person does not have a full seizure --in other words, they do not have convulsions, psychomotor symptoms or twitching characteristic of classic partial or generalized seizures.
In most instances, it presents as a "quick spin" type symptom. The person notes that the world makes a quick horizontal movement, lasting roughly one to two seconds at most. Quick spins must be differentiated from a variety of other conditions including vestibular neuralgia, Ménière's disease, and BPPV among others.
Diagnostic tests that are particularly helpful include the electroencephalograph (EEG) and magnetic resonance imaging (MRI) scan of the head.
How is Epileptic Vertigo Treated?
Treatment of epileptic vertigo disorder is generally supervised by a Neurologist. Epileptic vertigo generally responds well to traditional anticonvulsants such as carbamazepine and its relatives. There are many anticonvulsant medications that can be used.
Information Obtained From National Institute Of Health