Vertigo is a sensation of spinning or feeling off-balance, as if you or your surroundings are moving. While often associated with inner ear problems, vertigo can also indicate more serious underlying health conditions, including a stroke. Understanding the various causes of vertigo and recognizing specific warning signs is important for seeking appropriate and timely medical attention.
Understanding Vertigo
Vertigo is a specific type of dizziness characterized by a false sensation of movement, where an individual feels like they are spinning, tilting, swaying, or being pulled in one direction. It arises from dysfunction in the balance centers of the body, located either in the inner ear or the central nervous system. There are two primary categories of vertigo: peripheral and central.
Peripheral vertigo, the more common type, originates from issues within the inner ear or the vestibular nerve, which transmits balance signals to the brain. Common causes include benign paroxysmal positional vertigo (BPPV) and labyrinthitis or vestibular neuritis, which involve inflammation of the inner ear or vestibular nerve, often due to infection. This type of vertigo often presents with sudden, intense spinning sensations that can be triggered by head movements, sometimes accompanied by hearing loss, ringing in the ears, or a feeling of fullness in the ear.
Central vertigo, in contrast, stems from problems within the brain or brainstem, the regions that control balance and spatial awareness. While less common than peripheral vertigo, central vertigo can be a symptom of more serious conditions such as stroke, tumors, or multiple sclerosis. Unlike peripheral vertigo, central vertigo may be more persistent and severe, often causing profound balance issues that make walking difficult.
Vertigo Accompanying Stroke
When vertigo is a symptom of a stroke, it typically points to a posterior circulation stroke, affecting areas like the brainstem or cerebellum. These areas are important for balance and coordination, and a disruption of blood flow can manifest as vertigo. Vertigo alone is rarely the sole symptom of a stroke; it is almost always accompanied by other neurological signs.
Stroke-related vertigo often has a sudden onset and can be severe and persistent. These accompanying signs can include double vision or other vision changes, difficulty speaking (dysarthria), or facial drooping. Individuals might also experience weakness or numbness on one side of the body, severe headache, or problems with coordination and balance that are disproportionate to the spinning sensation.
Specific symptoms like slurred speech, trouble walking, or decreased consciousness alongside vertigo are particularly indicative of a brainstem stroke. Cerebellar strokes can also cause vertigo, along with nausea, slurred speech, and difficulty walking. The combination of vertigo with these other neurological deficits necessitates urgent medical evaluation, as prompt diagnosis and treatment are important for improving outcomes in stroke cases.
Urgent Warning Signs
The presence of certain “red flag” symptoms alongside vertigo requires immediate emergency medical attention. If vertigo starts suddenly and is severe, especially when accompanied by other neurological symptoms, it should prompt a call to emergency services. These urgent indicators include new confusion or trouble speaking, such as slurred speech or difficulty understanding words.
Other important warning signs are new numbness or weakness affecting the face, arm, or leg, or new clumsiness and difficulty with coordination. Vision changes, such as new double vision, blurred vision, or partial loss of sight, are also significant. A sudden, severe headache, unexplained vomiting, or an inability to stand or walk steadily even with support are additional symptoms that warrant immediate medical evaluation. These combined symptoms suggest a potential stroke, where timely intervention is important for minimizing damage.
Medical Evaluation for Vertigo
When vertigo occurs, a thorough medical evaluation is important to determine its cause, especially if there is concern for a stroke. Healthcare professionals will typically conduct a comprehensive neurological examination, which assesses balance, coordination, reflexes, and eye movements. They may perform specific eye movement tests, such as the Head Impulse, Nystagmus, and Test of Skew (HINTS) examination, which can help distinguish between central and peripheral causes of acute vestibular syndrome.
Imaging studies are often used to investigate the brain for structural issues. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans may be ordered to visualize the brain and rule out conditions like stroke or tumors. While CT scans have limited sensitivity for detecting acute ischemic strokes, especially in the posterior brain, MRI is generally more effective. These diagnostic steps aim to pinpoint the origin of vertigo and ensure serious underlying conditions receive timely treatment.