Vertigo is a special type of condition in which there is a subjective sensation of rotation of the environment and objects, or one’s own sensation of body rotation.
Dizziness can be both peripheral (damage to the vestibular nerve and labyrinth) and central – due to diseases affecting the central nervous system. The central type of vertigo is caused by the abnormal transmission, processing, and perception of nerve signals from the peripheral vestibular pathways, including the inner ear and vestibular nerve, to the central structures of the brain.
Maintaining our body’s balance is due to the correct functioning of our main sensory receptors – the vestibular receptor (located in the inner ear), the visual receptor and proprioceptive receptors, which sense our body’s position in space. The information presented by them is transmitted to brain structures – the brain stem and cerebellum, where it unites and “coordinates” the movements of the eyes and body to maintain the necessary balance. Last analyzer, which is also involved in providing feedback, – a bark of a brain.
The onset of dizziness is more common in old age due to increased risk factors – hypertension, atherosclerosis, diabetes and a corresponding increase in the risk of vascular complications. In younger people, the appearance of a “central” type of vertigo is often associated with the presence of migraine or demyelinating process.
When to think about “central” vertigo?
First of all, it is necessary to exclude the possibility of the occurrence of peripheral vestibular syndrome. The guideline for this is the history of the duration, the very manifestation of dizziness, as well as accompanying additional signs.
Some of the more common forms of peripheral vertigo are:
- Benign positional vertigo lasting about a few seconds or minutes
- Meniere’s dyndrome , which is a recurring episode of vertigo associated with hearing loss, pressure, and tinnitus that lasts several hours;
- vestibular apparatus neuronitis , lasting several days without concomitant neurological or auditory disorders.
Refusal of peripheral origin for vertigo, and the presence of concomitant neurological signs – including headache, temporary visual impairment, speech impairment, weakness, or sensory disturbances in the body – indicate a probable central cause of the vertigo.
What are the 4 most common “central” causes of vertigo?
1. Dizziness associated with migraine
The link between migraines and dizziness is different. In some cases, their appearance coincides in time, sometimes the headache precedes the onset of dizziness, and in most cases (50%) dizziness is the first complaint.
2. Violations of the vertebrobasilar vascular system
The vertebrobasilar system is responsible for the blood supply to most of the brain structures responsible for maintaining balance, including the inner ear. Therefore, a disorder in this system is often associated with the onset of dizziness, which can be chronic or acute.
3. Arnold’s vice – Chiari
It is the penetration of a part of the cerebellum and the brain stem through the so-called large cranial foramen and compression of the corresponding structures of the brain and cranial nerves. The most common complaints are dizziness, ataxia, sensorineural hearing loss, headache, neck pain, and cranial nerve dysfunction.
4. Multiple sclerosis
Although in most cases the first manifestation of the disease is the development of optic neuritis, in 5% of cases, dizziness is the first signal. In 50% of patients with multiple sclerosis, dizziness is an accompanying complaint throughout the disease.