Vertigo

Vertigo: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses

Vertigo is an illusion of movement in which the patient feels that he’s revolving in space (subjective vertigo) or that his surroundings are revolving around him (objective vertigo). He may complain of feeling as if he’s being pulled sideways, as though drawn by a magnet.

A common symptom, vertigo usually begins abruptly and may be temporary or permanent, mild or severe. It may worsen when the patient moves and subside when he lies down. It’s commonly confused with dizziness — a sensation of imbalance and light-headedness that’s nonspecific. However, unlike dizziness, vertigo is commonly accompanied by nausea, vomiting, nystagmus, and tinnitus or hearing loss. Although the patient’s limb coordination is unaffected, vertiginous gait may occur.

Vertigo may result from a neurologic or otologic disorder that affects the equilibratory apparatus (the vestibule, semicircular canals, eighth cranial nerve, vestibular nuclei in the brain stem and their temporal lobe connections, and eyes). However, this symptom may also result from alcohol intoxication, hyperventilation, postural changes (benign postural vertigo), the effects of certain drugs, tests, or procedures.

History

Ask your patient to describe the onset and duration of his vertigo, being careful to distinguish this symptom from dizziness. Does he feel that he’s moving or that his surroundings are moving around him? How often do the attacks occur? Do they follow position changes, or are they unpredictable? Find out if the patient can walk during an attack, if he leans to one side, and if he has ever fallen. Ask if he experiences motion sickness and if he prefers one position during an attack. Obtain a recent drug history. Note any evidence of alcohol abuse.

Physical assessment

Perform a neurologic assessment, focusing particularly on eighth cranial nerve function. Observe the patient’s gait and posture for abnormalities.

Medical causes

Acoustic neuroma

Acoustic neuroma is a tumor of the eighth cranial nerve that causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and — with cranial nerve compression — facial paralysis.

Benign positional vertigo

With benign positional vertigo, debris in a semicircular canal produces vertigo on head position change, which lasts a few minutes. It’s usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased level of consciousness (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve with herpes zoster produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly with this inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings of labyrinthitis include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

With Ménière’s disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Motion sickness

Motion sickness is characterized by vertigo, nausea, vomiting, and headache in response to rhythmic or erratic motions. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.

Multiple sclerosis

Episodic vertigo may occur early in multiple sclerosis and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. Multiple sclerosis may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures. The seizures may be heralded by an aura and followed by several minutes of mental confusion.

Vestibular neuritis

With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Also, administration of overly warm or cold eardrops or irrigating solutions can cause vertigo.

Special considerations

Place the patient in a comfortable position, and monitor his vital signs and LOC. Keep the side rails up if he’s in bed, or help him to a chair if he’s standing when vertigo occurs. Darken the room and keep him calm. Administer drugs to control nausea and vomiting and meclizine or dimenhydrinate to decrease labyrinthine irritability.

Prepare the patient for diagnostic tests, such as electronystagmography, EEG, and X-rays of the middle and inner ears.

Pediatric pointers

Ear infection is a common cause of vertigo in children. Vestibular neuritis may also cause this symptom.

Patient counseling

If the patient is experiencing vertigo, tell him not to get out of bed or walk without assistance. Instruct the patient not to make sudden position changes and to avoid tasks that can be dangerous such as driving.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

More About Ménière's disease

• Back to disease: Ménière's disease: Introduction
• Next Book Extract About Ménière's disease: Earache (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Earache (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

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