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07-SEPTEMBER-2008 03:17:44 - Vertigo medical January 2008 Vertigo medical Classification and external resources ICD-9 438.85 eMedicine neuro/ Vertigo from the Latin vertere, to turn, and the suffix -igo, a condition, i.e., a condition of turning about1 is a specific type of dizziness, a major symptom of a balance disorder. It is the sensation of spinning or swaying while the body is stationary with respect to the surroundings. There are two types of vertigo: subjective and objective. There is a subjective vertigo when a person has a false sensation of movement. In the case of objective vertigo, the surroundings appear to move past a person's field of vision. The effects of vertigo may be slight. It can cause nausea and vomiting and, in severe cases, it may give rise to difficulties with standing and walking. Contents 1 Causes 2 Neurochemistry 3 Diagnostic testing 4 Treatment 5 References 6 External links Causes Vertigo is usually associated with a problem in the inner ear balance mechanisms vestibular system, in the brain, or with the nerve connections between these two organs. Vertigo can be a symptom of an inner ear infection or of an underlying harmless cause. The most common cause of Vertigo is benign paroxysmal positional vertigo, or BPPV; however, vertigo can indicate the existence of more serious problems, including drug toxicities specifically gentamicin, strokes or tumors though these are much less common than BPPV, and syphilis. Vertigo can also be a symptom of multiple sclerosis MS. People with MS can feel off balance or lightheaded. Vertigo can also be brought on suddenly through various actions or incidents, such as skull fractures or brain trauma, sudden changes of blood pressure, or as a symptom of motion sickness while sailing, riding amusement rides, airplanes or in a motor vehicle. Vertigo can also be caused by carbon monoxide poisoning. It is also one of the more common symptoms of superior canal dehiscence syndrome and Meniere's disease. Vertigo-like symptoms may also appear as paraneoplastic syndrome PNS in the form of opsoclonus myoclonus syndrome, a multi-faceted neurological disorder associated with many forms of incipient cancer lesions or viruses. Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings. Vertigo can also occur after long flights or boat journeys where the mind gets used to turbulence, resulting in a person's feeling as if he is moving up and down. This usually subsides after a few days. Neurochemistry The neurochemistry of vertigo includes 6 primary neurotransmitters that have been identified between the 3-neuron arc that drives the vestibulo-ocular reflex VOR. Many others play more minor roles. Three neurotransmitters that work peripherally and centrally include glutamate, acetylcholine, and GABA. Glutamate maintains the resting discharge of the central vestibular neurons, and may modulate synaptic transmission in all 3 neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses. GABA is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells and the lateral vestibular nucleus, and the vertical VOR. Three other neurotransmitters work centrally. Dopamine may accelerate vestibular compensation. Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. It is known that centrally acting antihistamines modulate the symptoms of motion sickness. The neurochemistry of emesis overlaps with the neurochemistry of motion sickness and vertigo. Acetylcholine, histamine, and dopamine are excitatory neurotransmitters, working centrally on the control of emesis. GABA inhibits central emesis reflexes. Serotonin is involved in central and peripheral control of emesis but has little influence on vertigo and motion sickness. Diagnostic testing Tests of vestibular system balance function include electronystagmography ENG, rotation tests, Caloric reflex test,2 and Computerized Dynamic Posturography CDP. Tests of auditory system hearing function include pure-tone audiometry, speech audiometry, acoustic-reflex, electrocochleography ECoG, otoacoustic emissions OAE, and auditory brainstem response test ABR; also known as BER, BSER, or BAER. Other diagnostic tests include magnetic resonance imaging MRI and computerized axial tomography CAT or CT. Treatment Treatment is specific for underlying disorder of vertigo: vestibular rehabilitation anticholinergics antihistamines benzodiazepines calcium channel antagonists, specifically Verapamil and Nimodipine GABA modulators, specifically gabapentin and baclofen neurotransmitter reuptake inhibitors such as SSRI's, SNRI's and tricyclics benign paroxysmal positional vertigo BPPV, a special kind of vertigo, is treated with the Epley maneuver performed by a doctor or physical therapist, or with a BPPV maneuver at home References ^ Definition of vertigo - Merriam-Webster Online Dictionary. Retrieved on 2007-09-19. ^ Core Curriculum: Inner Ear Disease - Vertigo. Retrieved on 2007-09-19. External links Vertigo medical at the Open Directory Project Vertigo information Vertigo Information - Causes, Symptoms, Treatment v d e Diseases of the ear and mastoid process H60-H99, 380-389 External ear Otitis externa Middle ear and mastoid Otitis media - Mastoiditis Bezold's abscess, Gradenigo's syndrome - Cholesteatoma - Perforated eardrum Inner ear Otosclerosis - Balance disorder - Ménière's disease - Benign paroxysmal positional vertigo - Vestibular neuronitis - Vertigo - Labyrinthitis - Perilymph fistula - Superior canal dehiscence syndrome SCDS Hearing impairment Conductive hearing loss - Sensorineural hearing loss Central hearing loss, Presbycusis Other Tinnitus - Hyperacusis See also congenital v d e Symptoms and signs: cognition, perception, emotional state and behaviour R40-R46, 780-781 General Anxiety - Somnolence - Coma - Amnesia Anterograde amnesia, Retrograde amnesia - Dizziness/Vertigo Olfaction Anosmia - Hyposmia - Dysosmia - Parosmia - Hyperosmia Taste Ageusia - Hypogeusia - Dysgeusia - Parageusia - Hypergeusia Retrieved from http://en..org/wiki/Vertigo_medical Categories: Symptoms | Neurology | OtologyHidden category: Articles needing additional references from January 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Italiano Avañe'ẽ Dansk Deutsch Ελληνικά Español Français Bahasa Indonesia עברית Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português SlovenÄ?ina Suomi Svenska Türkçe Walon This page was last modified on 23 August 2008, at 23:56
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