Vertigo is a sensation of spinning or feeling that the world around you is spinning, even when you are still. It differs from general dizziness, which can feel like lightheadedness or unsteadiness. Vertigo is a symptom of various underlying health conditions, rather than a condition itself. Understanding the distinctions between different types of vertigo is important for determining the appropriate medical specialist to consult.
Understanding Vertigo Types
Vertigo is broadly categorized into two main types: peripheral and central. Peripheral vertigo arises from issues within the inner ear or the vestibular nerve, transmitting balance information. This type is more common and often linked to conditions such as Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s disease, or vestibular neuritis. These conditions affect the inner ear’s balance mechanisms or the nerve connecting them to the brainstem.
Central vertigo, in contrast, originates from problems within the brain or central nervous system, particularly areas like the brainstem or cerebellum that control balance and spatial orientation. This type can be associated with more serious neurological conditions. Examples of central vertigo causes include stroke, vestibular migraine, multiple sclerosis, or brain tumors. Distinguishing between these two types is important because it guides the diagnostic approach and the choice of medical specialist.
Neurologists and Vertigo Diagnosis
Neurologists specialize in disorders of the brain, spinal cord, and nerves, making them primary specialists for central vertigo diagnosis. When vertigo stems from neurological issues, a neurologist’s expertise is highly relevant. They assess symptoms, conduct thorough neurological examinations, and review medical history to identify potential central causes.
Conditions like vestibular migraine often fall under a neurologist’s diagnostic scope. Stroke, particularly those affecting the brainstem or cerebellum, can also cause vertigo and require urgent neurological evaluation. Multiple sclerosis and brain tumors are other central nervous system conditions diagnosed by neurologists that can cause vertigo. Their diagnostic process focuses on identifying signs of central nervous system dysfunction, such as specific patterns of involuntary eye movements (nystagmus) or other neurological deficits.
Diagnostic Approaches and Teamwork
Vertigo diagnosis often involves specialized tests and a collaborative approach among medical professionals. Neurologists frequently utilize imaging techniques such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans to visualize the brain and identify structural abnormalities causing central vertigo. MRI is often preferred due to its detailed visualization of the posterior fossa, a common site for central vertigo causes. These scans can help detect conditions like stroke, tumors, or multiple sclerosis.
Balance tests, such as videonystagmography (VNG) or electronystagmography (ENG), are commonly employed to assess the function of the vestibular system and eye movements. VNG, for example, evaluates how the inner ear functions by recording eye movements in response to various stimuli to differentiate between central and peripheral vestibular disorders. Audiometry, or hearing tests, may also be conducted, especially when inner ear issues are suspected, as conditions like Meniere’s disease can involve both vertigo and hearing changes.
While neurologists focus on central causes, they often work with other specialists like otolaryngologists (ENTs), who specialize in ear, nose, and throat conditions and typically manage peripheral vertigo. Physical therapists specializing in vestibular rehabilitation also contribute significantly to treatment plans once a diagnosis is established.
When to Consult a Neurologist
Certain symptoms accompanying vertigo suggest a central cause and warrant prompt neurological evaluation. If vertigo is accompanied by a severe headache, especially if sudden and unusual, or if there are changes in vision such as double vision or vision loss, seek immediate attention. Other concerning symptoms include difficulty speaking (slurred speech), weakness or numbness on one side of the body, or problems with coordination and walking.
Loss of consciousness or vertigo that begins after a head injury are also indicators for urgent neurological assessment. These “red flag” symptoms can point to serious neurological conditions like a stroke or brain hemorrhage, requiring timely diagnosis and intervention. Consulting a neurologist ensures potential central nervous system issues are thoroughly investigated.