What are the most common causes of vertigo?

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Vertigo is a sensation of spinning or dizziness, often caused by issues related to the inner ear, brain, or sensory pathways. The most common causes of vertigo include:

1. Benign Paroxysmal Positional Vertigo (BPPV)

Cause: BPPV occurs when tiny calcium crystals (otoconia) in the inner ear become dislodged and move into the semicircular canals, which are responsible for detecting head movement. This leads to incorrect signals about your position being sent to the brain, causing vertigo.
Symptoms: Short episodes of dizziness triggered by changes in head position, such as rolling over in bed or looking up.

2. Vestibular Neuritis

Cause: Vestibular neuritis is inflammation of the vestibular nerve, which connects the inner ear to the brain. It’s usually caused by a viral infection that affects the nerve, disrupting balance signals.
Symptoms: Sudden, intense vertigo, often accompanied by nausea and vomiting, but typically without hearing loss.

3. Ménière’s Disease

Cause: Ménière’s disease is a disorder of the inner ear that is thought to be related to fluid buildup. The exact cause is unclear, but it leads to abnormal signals in the balance and hearing systems.
Symptoms: Episodes of vertigo, fluctuating hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear. These symptoms may last from 20 minutes to several hours.

4. Labyrinthitis

Cause: Labyrinthitis is inflammation of the inner ear’s labyrinth (which includes the cochlea and vestibular system). Like vestibular neuritis, it is often caused by viral or bacterial infections.
Symptoms: Sudden onset of vertigo, combined with hearing loss and tinnitus. It typically affects one ear and may be accompanied by fever if due to bacterial infection.

5. Migrainous Vertigo (Vestibular Migraine)

Cause: Some individuals who suffer from migraines experience vertigo as part of their migraine attacks. The exact mechanism isn’t fully understood, but it may involve abnormal brain signaling affecting balance centers.
Symptoms: Episodes of vertigo associated with migraine symptoms, such as headache, sensitivity to light or sound, and visual disturbances. Vertigo may occur with or without a headache.

6. Head or Neck Injury

Cause: Trauma to the head or neck can damage the inner ear structures or disrupt nerve pathways that are responsible for maintaining balance.
Symptoms: Vertigo often develops after a traumatic event, such as a car accident or a fall, and may be accompanied by headaches or neck pain.

7. Stroke or Transient Ischemic Attack (TIA)

Cause: A stroke or TIA affecting the areas of the brain responsible for balance (e.g., the cerebellum or brainstem) can lead to vertigo.
Symptoms: Sudden, severe vertigo, often accompanied by other neurological symptoms, such as difficulty speaking, weakness on one side of the body, or double vision. Stroke-related vertigo is a medical emergency.

8. Ototoxic Medications

Cause: Some medications can damage the inner ear structures, leading to vertigo. These include certain antibiotics (aminoglycosides), diuretics, chemotherapy drugs, and high doses of aspirin.
Symptoms: Vertigo may develop while taking these medications and may be accompanied by hearing loss or tinnitus.

9. Perilymph Fistula

Cause: A perilymph fistula occurs when there is an abnormal connection between the middle ear and inner ear, allowing fluid to leak from the inner ear. This can result from head trauma, surgery, or extreme pressure changes (e.g., scuba diving).
Symptoms: Vertigo, hearing loss, and tinnitus, often triggered or worsened by changes in pressure, such as sneezing or lifting heavy objects.

10. Acoustic Neuroma

Cause: An acoustic neuroma is a benign (non-cancerous) tumor that grows on the vestibulocochlear nerve, which connects the inner ear to the brain. It can interfere with balance and hearing as it grows.
Symptoms: Gradual onset of vertigo, hearing loss (typically in one ear), tinnitus, and sometimes facial numbness or weakness.

11. Dehydration or Hypotension

Cause: Dehydration or a significant drop in blood pressure (orthostatic hypotension) can reduce blood flow to the brain, leading to dizziness or vertigo.
Symptoms: Lightheadedness, faintness, or a spinning sensation, especially when standing up quickly.

12. Anxiety or Panic Attacks

Cause: Anxiety or panic attacks can trigger dizziness or a sensation of vertigo due to hyperventilation or changes in the body’s stress response.
Symptoms: Vertigo associated with rapid breathing, a racing heart, and a feeling of impending doom during an anxiety or panic attack.

Summary:

The most common causes of vertigo are inner ear issues, such as BPPV, vestibular neuritis, and Ménière’s disease. Other causes include migraines, head injuries, and neurological conditions like stroke. Treatment depends on the underlying cause and may involve repositioning maneuvers (e.g., Epley maneuver for BPPV), medication, physical therapy, or, in rare cases, surgery. If vertigo is accompanied by neurological symptoms (e.g., difficulty speaking, facial weakness), it could indicate a stroke and requires immediate medical attention.

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