Vertigo is the sensation that you or the world around you is spinning. It is a symptom, not a diagnosis. Understanding the cause is the key to effective treatment.
Vertigo is the illusion of movement — typically a spinning sensation — in the absence of actual motion. It is not the same as lightheadedness or generalised dizziness, though these are often confused. Vertigo arises from a disturbance in the vestibular system — the sensory system responsible for detecting motion, head position and spatial orientation — which is located primarily in the inner ear, with central processing in the brainstem and cerebellum.
Vertigo is broadly classified as peripheral (originating in the inner ear) or central (originating in the brain or brainstem). This distinction is critical because central vertigo can indicate a serious underlying neurological condition.
Peripheral vertigo — the more common type — includes conditions such as:
Central vertigo may result from stroke, multiple sclerosis, cerebellar atrophy, migraine or space-occupying lesions. Central vertigo must be excluded in any patient presenting with vertigo, particularly when associated with neurological symptoms.
Vertigo associated with any of the following demands immediate neurological assessment: sudden severe headache, double vision, difficulty speaking or swallowing, weakness or numbness in the limbs, loss of coordination or gait disturbance. These may indicate a cerebellar or brainstem stroke — a medical emergency.
Accurate diagnosis of vertigo requires a detailed clinical history, a thorough neurological and otological examination and — in selected cases — specialised investigations such as the Head Impulse Test, HINTS battery assessment, audiometry, videonystagmography and, where central causes are suspected, MRI of the brain. The HUTT test (Head-Up Tilt Test) is valuable in evaluating patients with syncope or near-syncope associated with positional symptoms.
RVR Super Speciality Centre is one of very few centres in Mangalore equipped to perform comprehensive vestibular evaluation including HUTT testing. Our ENT and Neurology teams collaborate to ensure accurate diagnosis — because vertigo that looks peripheral may, in some cases, be central.
BPPV — the most common cause — responds very well to the Epley manoeuvre and other repositioning techniques performed by a trained clinician. Vestibular neuritis is managed with vestibular suppressants in the acute phase followed by vestibular rehabilitation exercises. Meniere's disease requires a multifaceted approach including dietary modification, medication and, in refractory cases, procedural intervention. Central vertigo is managed according to the underlying cause.