Vertigo

Vertigo: Excerpt from Nursing: Interpreting Signs and Symptoms

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 pulled sideways, as though drawn by a magnet.

A common symptom, vertigo usually begins abruptly and may be temporary or permanent and mild or severe. It may worsen when the patient moves and subside when he lies down. It's often confused with dizziness—a sensation of imbalance and light-headedness that's nonspecific. However, unlike dizziness, vertigo is commonly accompanied by nausea and vomiting, nystagmus, and tinnitus or hearing loss. And, 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, and postural changes (benign postural vertigo). It may also be an adverse effect of certain drugs, tests, or procedures.

History and physical examination

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 whether he experiences motion sickness and if he prefers one position during an attack. Obtain a recent drug history, and note evidence of alcohol abuse.

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

Herpes zoster.Herpes infection of the eighth cranial nerve 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 labyrinthitis. Vertigo may occur in a single episode or may recur over months or years. Associated findings 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, a sudden motion of the head or eyes can precipitate nausea and vomiting.

Multiple sclerosis (MS).With MS, episodic vertigo may occur early and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. MS 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.

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. Administration of overly warm or cold eardrops or irrigating solutions can also cause vertigo.

Nursing considerations

▪ Place the patient in a comfortable position.

▪ Monitor vital signs and LOC.

▪ Take measures to provide for the patient's safety.

▪ Darken the room and keep the patient calm.

▪ Administer drugs to control nausea and vomiting and decrease labyrinthine irritability.

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

Patient teaching

▪ Explain to the patient the underlying cause of vertigo and its treatment.

▪ Explain safety measures to the patient.

▪ Tell the patient to avoid sudden position changes and dangerous tasks.

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, 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 (Differential Diagnosis in Primary Care)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

 » Next page: EARACHE (Differential Diagnosis in Primary Care)

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