Vertigo Treatment – FAQs

Vertigo is the feeling that you or your environment is moving when no movement occurs. Imprecisely called dizziness, it is described as an illusion of movement.

• Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements.
• Inflammation within the inner ear (labyrinthitis). This condition is characterized by the sudden onset of vertigo and may be associated with hearing loss.
• Meniere’s disease is composed of a triad of symptoms: episodes of vertigo, ringing in the ears, and hearing loss.
• Acoustic neuroma is a type of tumor causing vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss.
• Vertigo can be caused by decreased blood flow to the brain and base of the brain. Bleeding into the back of the brain called cerebellar hemorrhage is characterized by vertigo, headache, difficulty in walking, and inability to look toward the side of the bleed. The result is that the person’s eyes gaze away from the side with the problem. Walking is also extremely impaired.
• Multiple sclerosis in which there is inability of the eyes to move past the midline toward the nose.
• Head trauma
• Migraine, a severe form of headache, may also cause vertigo.
• Ligamental injuries of the upper cervical spine can result in head-neck-joint instabilities which can cause vertigo

Vertigo should not be confused with symptoms of lightheadedness or fainting. To determine if true vertigo exists, you must describe a sensation of disorientation or motion. In addition, you may also have any or all of these symptoms:

Nausea or vomiting, sweating and abnormal eye movements. The duration can be from minutes to hours and can be constant or episodic. The onset may be due to movement or change in position. It is important to tell your doctor about any recent head trauma as well as any new medications you may be taking. You may have hearing loss and a ringing sensation in your ears. You might have visual disturbances, weakness, difficulty speaking, decreased level of consciousness, and difficulty in walking.

The majority of cases of vertigo are harmless but let your doctor check out any new signs and symptoms of vertigo to rule out any potentially serious or life-threatening causes. Certain signs and symptoms of vertigo may require evaluation in a hospital’s emergency department:

Double vision, headache, weakness ,difficulty in speaking, abnormal eye movements, altered level of consciousness, not acting appropriately, or difficulty in arousing, difficulty in walking or controlling your arms and legs.

The evaluation of vertigo consists primarily of a medical history and physical exam.

• The history is comprised of 4 basic areas. The doctor will ask you about the following areas:
  • During the exam, the doctor will want to find out if true vertigo exists. Report any sensation of motion, nausea, vomiting, sweating, and any abnormal eye movements.
  • The doctor will ask about how long you have had symptoms and whether they are constant or come and go. Do the symptoms occur when you move or change position? Are you currently taking any new medications? Has there been any recent head trauma or whiplash injury?
  • Are there any other hearing symptoms? Specifically, report any ringing in the ears or hearing loss.
  • Do you have weakness, visual disturbances, altered level of consciousness, difficulty in walking, abnormal eye movements, or difficulty in speaking?
• The doctor may perform special tests such as a CT scan if a brain injury is suspected, blood tests, specifically to check blood sugar levels, and the use of an ECG to look at the heart rhythm.

Home therapy should only be undertaken if you have already been diagnosed with vertigo and are under the close supervision of a doctor.

The choice of treatment will depend on the diagnosis.

• Vertigo can be treated with medicine you take by mouth, as a skin patch, or drugs given through an IV.
• Specific types of vertigo may require additional treatment and referral:
• • Bacterial infection of the middle ear requires antibiotics.
  • For Meniere disease, in addition to symptomatic treatment, people might be placed on a low salt diet and may require medication used to increase urine output.
  • A hole in the inner ear causing recurrent infection may require referral to an ear, nose, and throat (ENT) specialist for surgery.
• In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.
  • Vestibular rehabilitation exercises consist of having you sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo is no longer inducible.
  • Particle repositioning maneuver is a treatment based on the idea that the condition is caused by small stones in the inner ear. Your head is repositioned to move the stones to their normal position. This maneuver should be repeated until the abnormal eye movements are no longer visible.

Medications commonly prescribed are :Meclizine hydrochloride (Antivert), Diphenhydramine (Benadryl), Scopolamine transdermal patch, Promethazine hydrochloride (Phenergan) and Diazepam (Valium) Take these medications only as directed by and under the supervision of your doctor.

Anyone with a new diagnosis of vertigo should follow up with their doctor or be referred directly to a neurologist or ENT specialist.

• People whose balance is affected by vertigo should take precautions to prevent injuries from falls.
• Those with risk factors for stroke should control their high blood pressure and high cholesterol and stop smoking.
• Someone with Meniere disease should limit added salt to their diet.

The prognosis depends on the source of the vertigo.

• Vertigo caused by problems in the inner ear, while usually self-limited, in some cases can become completely incapacitating. The use of drugs and rehabilitation exercises are the mainstay of treatment. Most commonly this will make the symptoms completely go away or make the condition tolerable.
• The prognosis of vertigo from a brain lesion depends on the amount of damage done to the central nervous system. All vertigo caused by a brain lesion needs emergency evaluation by a neurologist and Video electroencephalogram.

It is a procedure when the EEG is recorded for a prolonged period after an advice from the physician and is accompanied by continuous closed-circuit video observation. The digitized EEG and recorded behaviour are displayed simultaneously, allowing point-to-point correlations of recorded events and any accompanying electrographic changes. This allows localisation of seizure origin.

Epilepsy is a disease of the brain caused by abnormal electrical activity. Video EEG monitoring enables your doctor to observe your seizures and the EEG at the same time. Video monitoring can help diagnose your seizure type and provides important information regarding the best treatment for your seizures. Video monitoring is also used in the evaluation for epilepsy surgery. In some patients, epilepsy can be helped or even cured by surgery. Video EEG monitoring is considered medically necessary when specific patient selection criteria are met, as outlined below may be considered for other situations. Video EEG monitoring is considered appropriate for patients who meet any of the following criteria:

• Diagnosis could not be made on the basis of a neurological examination and /or standard EEG studies.
• Presence of intractable / uncontrolled seizure activity despite conventional treatment, including anti-epileptic medication(s) and adequate dosage of medication(s) and patient compliance has been assured.
• Non epileptic seizures secondary to other diagnoses have been ruled out (e.g. syncope, transient ischemic attacks, etc.).
• To differentiate between true seizures and pseudo seizures.

It shall be performed on an inpatient basis, depending on the frequency and duration of seizure activity and length of time necessary to collect data. EEG monitoring would be required for patients such as those having infrequent clinical seizures, with seizures that are clinically severe (such as prolonged complex partial seizures), or are provoked by drug withdrawal.

A video recording is done by 21 to 44 channel EEG monitoring in order to capture the patient’s behaviour and the corresponding EEG pattern.

The video EEG allows clinicians to examine changes in the EEG along with the clinical manifestations of seizures as they occur.

• Patient is asked to bring all previous medical records and out patient prescriptions.
• They must tell the physician about history of medication intake
• Instructions given to the patient the night before to:
  • Avoid caffeine for 24 hours before the EEG.
  • Eat normally
  • Limit or avoid smoking for 24 hours before the test
  • Shampoo the hair before the EEG.
  • Do not apply hair spray or gel before the EEG
  • Stoppage of antiepileptic drugs before 24 hours or as instructed by the consultant

• The staff receives the request for EEG duly signed by a Senior Consultant/ designee.
• He /she ensures that patients get registered on the counter and checks the bill. The technician introduces himself and explains the EEG procedure to the patient under supervision of consultant.
• Technician obtains all patient data needed for the EEG report and billing i.e. patient’s name, medical record number, date of birth, referring physician, patient location, and procedure number.
• Clinical information including type of procedure requested, reason for EEG, relevant symptoms, and description of seizure and current medications shall be checked by the doctor.
• The physician ensures medications are listed and spelled correctly.
• Thereafter the patient data is logged in correctly.
• The technician verifies physician signature on request form and thereafter adjusts the machine settings to obtain optimum accurate recording.
• Electrodes are applied correctly within 30 minutes, their functioning verified and the patient instructed to open and close eyes, hyperventilation and photic stimulation.
• Significant EEG patterns include normal variants, artefact patterns and abnormal EEG patterns are identified, electrodes removed correctly and the patient’s scalp cleaned.
• All the EEG data for interpretation by the consultant is edited / archived by the technician

During the procedure The patient’s state of alertness is measured periodically. Patients with coma or altered mental state may be tested with auditory or tactile stimulation. Patients with seizures or pseudo seizures are tested for responsiveness.

Photic stimulation and hyperventilation: The patient is asked to perform 3 minutes of hyperventilation when there are none of the contraindications of cardiac / respiratory disease / sickle cell disease / severe hypertension /acute stroke.

All medical procedures carry a certain amount of risk. Although video monitoring is relatively safe, one could have an uncontrollable seizure, or may experience unusually severe seizures or could confront with emotionally upsetting information when the doctor should be consulted.