Vertigo Signs and Symptoms

• True vertigo is a type of dizziness wherein the patient experiences a false sense of spinning or rotational motion in the surroundings or within oneself even when there is no physical movement
• May be secondary to different causes that may be determined by numerous factors eg timing and duration, aggravating conditions or associated symptoms

Timing and duration of vertigo

• Vertigo lasting a few seconds: Acute vestibular neuronitis (late stages), Meniere’s disease (late stages)
• Several seconds to a few minutes: Benign paroxysmal positional vertigo (BPPV), perilymphatic fistula, vestibular paroxysmia
• Several minutes to 1 hour: Posterior transient ischemic attack (TIA), perilymphatic fistula
• Hours: Meniere’s disease, perilymphatic fistula from trauma or surgery, migraine, acoustic neuroma
• Days: Early acute vestibular neuronitis, stroke, migraine, multiple sclerosis (MS)
• Weeks: Psychogenic (vertigo lasts for weeks without improvement)

Provoking or aggravating factors

• Changes in head position: Acute labyrinthitis, benign paroxysmal vertigo, cerebellopontine angle tumor, multiple sclerosis, perilymphatic fistula, Meniere’s disease, acute vestibular neuronitis
• Recent upper respiratory viral infection: Acute vestibular neuronitis, acute labyrinthitis
• Stress: Migraine, psychiatric or psychological causes
• Immunosuppression: Herpes zoster oticus
• Changes in ear pressure, trauma, excessive straining, loud noises: Perilymphatic fistula

Severity of vertigo over time

• In acute vestibular neuronitis, initial symptoms are typically severe but lesser over the following days
• In Meniere’s disease, vertigo attacks may occur in clusters at first, but frequency of episodes may decrease over time
• In psychological causes, vertigo remains constant for several weeks

Associated symptoms occurring with vertigo

• Feeling of fullness in the ear: Acoustic neuroma, Meniere’s disease
• Ear or mastoid pain: Acoustic neuroma, acute middle ear disease, herpes zoster oticus
• Facial weakness: Acoustic neuroma
• Neurologic findings: Cerebellopontine angle tumor, cerebrovascular disease, multiple sclerosis
• Headache: Acoustic neuroma, migraine
• Hearing loss: Meniere’s disease, perilymphatic fistula, acoustic neuroma, transient ischemic attack or stroke involving anterior inferior cerebellar artery, herpes zoster oticus, cholesteatoma, otosclerosis
• Imbalance: Acute vestibular neuronitis, cerebellopontine angle tumor, Meniere’s disease
• Tinnitus: Acute labyrinthitis, acoustic neuroma, Meniere’s disease
• Nausea or vomiting: Acute vestibular neuronitis, benign paroxysmal vertigo, Meniere’s disease, cerebrovascular stroke
  • If neurologic symptoms appear as well, central causes of vertigo should be considered