Question

A 40-year-old man comes to the OPD with complaints of spinning around him.
What are the causes of vertigo?

Hint:

Always consider both peripheral (e.g., BPPV, Meniere's) and central causes (e.g., stroke, brain tumors) when evaluating vertigo. A proper diagnosis guides the management.

Answer 1

Step 1: Peripheral Causes of Vertigo.
- Benign Paroxysmal Positional Vertigo (BPPV): The most common cause of peripheral vertigo. It occurs due to dislodged otoliths (calcium carbonate crystals) in the semicircular canals, causing a sudden sensation of spinning when the head is moved.
- Meniere's Disease: Characterized by episodic vertigo, tinnitus, and hearing loss due to fluid buildup in the inner ear.
- Vestibular Neuritis: Inflammation of the vestibular nerve, usually following a viral infection, leading to sudden vertigo without hearing loss.
- Labyrinthitis: Inflammation of both the cochlear and vestibular nerves, typically associated with hearing loss and vertigo following an upper respiratory infection.

Step 2: Central Causes of Vertigo.
- Cerebrovascular Events: A stroke or transient ischemic attack (TIA) affecting the brainstem or cerebellum can cause vertigo.
- Multiple Sclerosis (MS): MS can cause vertigo due to demyelination of the vestibular pathways.
- Brain Tumors: Tumors in the cerebellum or brainstem can cause vertigo, often with other neurological signs.

Step 3: Conclusion.
Vertigo can result from a variety of peripheral or central causes. A thorough history and examination are required to differentiate between these causes.