ROOM SPINNING?

​Vertigo is the feeling that the room is spinning or moving around you.  It is often caused by a temporary fluid imbalance in the inner ear, which will resolve independently.   Vertigo is not a diagnosis; instead, it is an indicator of other conditions, and some of these conditions can be life-threatening.  It can also originate from an issue in the brain, which is more severe and can include stroke, multiple sclerosis, a tumor, or bleeding. 
 
Vertigo often worsens when standing and makes you feel unable to walk straight.  Many people have nausea or vomiting with it, too.

Is The Room Spinning Or Moving Around You?
By Pierre Mouchette | Bits-n-Pieces

Vertigo is a feeling that the room or world is spinning around you.  Most of us have experienced it some time in life.  It is the same sensation you have after spinning around in an office swivel chair.  In that scenario, we know the sensation will pass once we regain balance.  However, some people experience vertigo out of the blue, and what is worse, it does not go away immediately.
Several different things can cause vertigo.  Most often, this is caused by a condition that affects a part of the ear that helps with balance and will not come with serious health risks.  However, sometimes vertigo can be caused by something in the brain that may be more serious.
 
Are there different types of vertigo?
There are two main types of vertigo:

• Peripheral: coming from the ear
• Central: coming from the brain

Peripheral vertigo is more common.  It happens when something is off in the inner ear, composed of different parts that help you feel steady and balanced.  The inner ear contains special fluids and crystals that help the brain understand when your body moves.  Changes to the body position are then communicated to the brain by the vestibular nerve, which allows us to maintain balance.
Central vertigo is less common than peripheral vertigo.  It occurs when there is a problem with the brain.  It could be an issue with the part of the brain at the back of your head, known as the cerebellum.  The cerebellum has many essential functions, one of which is maintaining balance.  Or it can be an issue with the brain stem, which helps with balance.  Central vertigo develops if one or both of these areas are affected.
 
What causes vertigo?
Different underlying diagnoses cause peripheral and central vertigo. 
The most common causes of peripheral vertigo are:

• Benign paroxysmal positional vertigo (BPPV):  This is when crystals in the inner ear move into a position that disrupts the fluid that helps with balance.  It sends a confusing message to the brain, making it difficult for the brain to know the body's position.  BPPV is the leading cause of peripheral vertigo.
  
  
• Ménière's disease:  This is when a build-up of fluid in the inner ear interferes with the brain's ability to interpret if your body is moving.  This condition can also affect a person's hearing.
  
  
• Labyrinthitis:  Also known as vestibular neuritis, is inflammation of the inner ear usually triggered by a virus similar to the ones that can cause the common cold.
  
  
• Cholesteatoma:  This is the abnormal growth of skin behind the eardrum.  Some people have a cholesteatoma when they are born, while others develop one after multiple ear infections.
  
  
• Acoustic neuroma:  Also called vestibular schwannoma, it is a benign tumor that tends to grow slowly on your vestibular nerve.

Central vertigo is much less common than peripheral vertigo.  Some causes of central vertigo include:

• Stroke:  Vertigo is not a typical symptom of a stroke.  But vertigo can be one of the symptoms if a stroke affects blood vessels to the cerebellum or brain stem.
  
  
• Head trauma:  Just like a stroke, bleeding inside the brain can cause vertigo, depending on where the injury is.
  
  
• Migraine headache:  Most people are familiar with how migraines cause a throbbing headache, sensitivity to light, and nausea.  But some people get vertigo symptoms with their migraine, too.
  
  
• Multiple sclerosis:  An autoimmune disease that involves the body attacking the nerves in the brain and spinal cord.  More common symptoms of multiple sclerosis are weakness, difficulty walking, and vision changes.
  
  
• Brain tumor:  While possible, it is a very uncommon cause of vertigo.

 
Do symptoms differ depending on the type of vertigo?
The symptoms of vertigo can vary from person to person.  And peripheral and central vertigo can feel very similar.  So you cannot always tell what is causing vertigo based on symptoms alone.  But, sometimes, some clues can help.
The causes of peripheral vertigo can lead to:

• Dizziness
• Increased sweating
• Severe nausea and vomiting
• Ringing in the ear
• Feeling of fullness in the ear
• Difficulty focusing your eyes or double vision

Note:  dizziness is different from vertigo.  It is a feeling of being off balance, whereas vertigo is the sensation of the room moving around you.
 
Causes of central vertigo can also cause all of the above symptoms.  But central vertigo lasts longer than peripheral vertigo, which can disappear after a few seconds or hours.  Although the causes of central vertigo are more serious, it often feels less severe than peripheral vertigo.  Causes of central vertigo are also less likely to lead to a feeling of fullness or ringing in the ear.
In addition, people with central vertigo may experience the following: 

• Headaches
• Weakness in one arm or one leg, similar to a stroke
• Trouble swallowing
• Slurred speech
• Facial paralysis

 
When to see a provider
Many individuals with conditions that cause vertigo, like BPPV or Ménière's, are familiar with vertigo attacks and how to recoup from them.  But if you are experiencing your first outbreak, the symptoms may feel severe and alarming.  It is natural to question if you should seek emergency medical care instead of waiting for the scheduled appointment with your provider.
You should look for emergency evaluation if experiencing any of the following symptoms along with vertigo:

• Weakness in one arm or leg
• Numbness in an arm or leg
• Loss of vision or changes in sight beyond the spinning sensation of vertigo
• Difficulty speaking
• Difficulty swallowing
• Confusion, disorientation, or lethargy
• Inability to stand or walk
• Severe headache
• Uncontrollable vomiting 

 
Beyond symptoms, other factors determine if you should seek evaluation immediately.  These include:

• Age:   As you age, the risk increases for conditions that can cause central vertigo, such as stroke.  So if you are 60 or older and experiencing vertigo for the first time, it is best to be evaluated to figure out what is causing it.
  
  
• Blood-thinning medications:  These medications increase the likelihood of brain bleeding.
  
  
• Recent head trauma:  Also increases the possibility of bleeding in the brain.
  
  
• Higher risk of a stroke:   Several conditions that increase the risk of stroke are high blood pressure, high cholesterol, diabetes, and atrial fibrillation.