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Are there specific steps and diagnostic measures for identifying early signs of vertigo?

Vertigo serves as a symptom rather than a definitive diagnosis, making it imperative to consult a healthcare professional for an accurate determination of its root cause[1].

Steps for Diagnosis:

  1. Consult a medical professional: The initial step in addressing vertigo involves consulting with a qualified healthcare provider.
  2. Comprehensive history and symptom assessment: A detailed history and symptom analysis are the cornerstone of an accurate diagnosis[2].
  3. Specialized examination: This includes a general physical examination and specific vestibular tests tailored to the patient's symptoms.

Vestibular Diagnostic Tests:

Based on the symptoms presented, a range of vestibular tests may be recommended:

  1. Dynamic Visual Acuity (DVA): This test evaluates the ability to maintain visual focus while in motion[3].
  2. Video Head Impulse Test (vHIT): This test assesses the vestibulo-ocular reflex, offering insights into the functioning of the inner ear[4].
  3. Caloric Irrigation Test: This involves warming and cooling the inner ear to induce nystagmus, involuntary eye movements, which are then analyzed[5].
  4. Additional Diagnostic Measures: Further tests, such as MRI Brain and Audiometry, may also be advised depending on the individual case.
  1. Neuhauser HK, et al. Dizziness: State of the Science-Annals of the New York Academy of Sciences, 2009; 1164:1–45. 
  2. Newman-Toker DE, et al. Diagnosis of Vertigo,"Medical Clinics of North America, 2015; 99(5): 879–901. 
  3. Herdman SJ, et al. Dynamic Visual Acuity in Patients with Unilateral Vestibular Hypofunction, Journal of Vestibular Research, 2001; 11(5): 373–379. [PubMed](
  4. MacDougall HG, et al. The Video Head Impulse Test, Frontiers in Neurology 2013; 4: 279.
  5. Halmagyi GM, et al. The Caloric Test-Journal of Neurology, Neurosurgery, and Psychiatry, 2010; 81(11): 1239–1241. 

What is the role of Video-Nystagmography (VNG) in diagnosing vertigo?

The significance of eye movements 

Eyes are not just organs for vision; they also play a crucial role in focusing and shifting attention from one target to another. These eye movements are finely tuned according to the head's position and velocity, thanks to intricate brain circuits[1].

Eye movements as diagnostic tools

Abnormalities in these brain circuits can manifest as eye movement disorders, making the eyes a valuable diagnostic window for various neurological conditions[2].

How VNG aids in diagnosis

VNG is a specialized diagnostic tool that captures video recordings of eye movements. During the VNG test, patients wear VNG goggles and sit in front of a screen displaying various visual stimuli
The eye movements elicited by these stimuli are recorded in both graphical and video formats. This comprehensive record is instrumental in the precise diagnosis, monitoring, and treatment of neurological disorders, including vertigo[3].

  1. Leigh RJ, Zee DS. "The Neurology of Eye Movements, Oxford University Press, 2015.
  2. Ramat S, et al. What Clinical Disorders Tell Us about the Neural Control of Saccadic Eye Movements, Brain, 2007; 130(Pt 1): 10–35.
  3. Fife TD, et al. Practice Parameter: Therapies for Benign Paroxysmal Positional vertigo (An Evidence-Based Review), Neurology, 2008; 70(22): 2067–2074.

Treatment Options for Patients with Vertigo: A Tailored Approach

Understanding Vertigo as a Symptom

It's crucial to recognize that vertigo is a symptom rather than a standalone diagnosis[1]. Therefore, the cornerstone of effective treatment is an accurate diagnosis of the underlying cause.

Treatment Based on Diagnosis

  1. Vestibular Migraine:
    For patients diagnosed with vestibular migraine, the treatment primarily involves lifestyle modifications and preventive medications specifically for migraine[2].
  2. Benign Paroxysmal Positional Vertigo (BPPV): 
    In cases where BPPV is the diagnosed cause, specialized repositioning maneuvers are the treatment of choice. These maneuvers are performed by experts in the field[3].
  3. Neurological conditions: 
    For vertigo caused by conditions like stroke, multiple sclerosis, or tumors, the treatment focuses on managing the underlying disease itself[4].
  1. Baloh RW, Honrubia V. "Clinical Neurophysiology of the Vestibular System, Oxford University Press , 2001. 
  2. Lempert T, Olesen J, Furman J, et al. Vestibular Migraine: Diagnostic Criteria, Journal of Vestibular Research , 2012; 22(4): 167–172.
  3. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo, Otolaryngology–Head and Neck Surgery, 2017; 156(3): 403–416. 
  4. Strupp M, Brandt T. Diagnosis and Treatment of Vertigo and Dizziness, Deutsches Ärzteblatt International , 2008; 105(10): 173–180. 

What are some common myths about vertigo, and how can we dispel these misconceptions?

Myth 1

Cervical spondylosis is the leading cause of vertigo.
Contrary to popular belief, true spinning vertigo is rarely caused by cervical spondylosis[1]. While cervical issues can lead to dizziness under specific conditions, they are not as prevalent as vestibular migraine and Benign Paroxysmal Positional Vertigo (BPPV).

Myth 2

Low blood pressure causes vertigo.
Many patients mistakenly attribute vertigo to low blood pressure. While low blood pressure (syncope) can lead to blackouts or even loss of consciousness under certain conditions, it is not a common cause of vertigo[2].

Myth 3

Migraine only causes headaches, not vertigo.
Migraine is, in fact, one of the most common causes of vertigo and dizziness worldwide[3]. Vertigo and imbalance can occur with or without associated headaches. In one-third of vestibular migraine cases, patients either don't remember or dismiss their migraine headaches as “normal headaches”.

Myth 4 

Medication is the only treatment for vertigo.
Not all vertigo conditions require medication for treatment[4]. For instance, BPPV is primarily treated with repositioning maneuvers, not medication. Additionally, vestibular rehabilitation therapy plays a significant role in treating certain conditions like unilateral or bilateral vestibulopathy and Persistent Postural Phobic Dizziness (PPPD).

  1. Brandt T, Bronstein A. Cervical vertigo,Journal of Neurology, Neurosurgery & Psychiatry , 2001; 71(1): 8–12. 
  2. Parry SW, Reeve P, Lawson J, et al. The Newcastle protocols 2008: an update on head-up tilt table testing and the management of vasovagal syncope and related disorders, Heart , 2009; 95(5): 416–420. 
  3. Lempert T, Olesen J, Furman J, et al. Vestibular Migraine: Diagnostic Criteria, Journal of Vestibular Research, 2012; 22(4): 167–172. 
  4. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo,"Otolaryngology–Head and Neck Surgery , 2017; 156(3): 403–416. 
Dr Vishal Pawar

Vishal Pawar

Neurologo Specialista

Dr. Vishal Pawar - Neurologo Specialista MBBS, DNB Medicine, DNB Neurology, SCE Neuro (RCP UK), VAM (American institute of Balance), Diploma Internazionale di Vestibologia, Membro del Comitato Europeo di Neurologia.
Il dottor Pawar è uno specialista in neurologia con diversi anni di esperienza nel settore. La sua area di competenza si concentra sul trattamento di pazienti affetti da cefalee, vertigini, ictus e mal di schiena. È relatore a congressi, seminari e webinar nazionali e internazionali e autore di pubblicazioni su riviste scientifiche nazionali e internazionali.


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