Vertigo and Dizziness: Neurological Causes, Warning Signs and Treatment

Dizziness is one of the most common reasons people see a doctor, and one of the most confusing symptoms to describe. Some people feel the room spinning. Others feel faint, woozy or unsteady on their feet. Because these sensations come from different parts of the body, the first step toward the right treatment is figuring out exactly what kind of dizziness you have.

This article explains the types of dizziness, the most common causes of vertigo, the warning signs that need emergency care and how a neurologist evaluates and treats these symptoms.

Types of Dizziness

When you describe your symptoms to your doctor, try to be as specific as possible. Neurologists usually think about dizziness in a few categories:

• Vertigo: a false sense of motion, usually spinning, either of yourself or of the room. Vertigo typically comes from the inner ear (the vestibular system) or from the parts of the brain that process balance.
• Lightheadedness or presyncope: feeling faint or about to pass out, often related to blood pressure, heart rhythm, dehydration or medications.
• Disequilibrium: unsteadiness or imbalance when standing or walking, without spinning. This can be caused by nerve damage in the feet, problems in the cerebellum, vision problems or several factors combined.
• Vague dizziness: a foggy or floating feeling, sometimes linked to anxiety, migraine or medication side effects.

It also helps to notice timing and triggers: How long does each episode last? Is it triggered by rolling over in bed, standing up or turning your head? Is it constant?

Common Causes of Vertigo

Benign paroxysmal positional vertigo (BPPV)

BPPV is the most common cause of vertigo. Tiny calcium crystals in the inner ear become dislodged and move into one of the balance canals. Certain head movements, such as rolling over in bed, looking up or bending down, then cause brief, intense spinning that usually lasts less than a minute. BPPV is not dangerous and is often treated effectively in the office with repositioning maneuvers, such as the Epley maneuver, which guide the crystals back to where they belong.

Vestibular neuritis and labyrinthitis

Inflammation of the balance nerve, often after a viral illness, causes sudden, severe, constant vertigo with nausea and vomiting that lasts for days, then gradually improves over weeks. When hearing is also affected, it is called labyrinthitis.

Vestibular migraine

Migraine can cause episodes of vertigo lasting minutes to hours, sometimes with no headache at all. Many patients have a personal or family history of migraine, motion sensitivity or light sensitivity during attacks. Treating migraine often reduces the dizziness. Read more about migraine prevention.

Ménière's disease

Episodes of vertigo lasting 20 minutes to several hours, together with fluctuating hearing loss, ringing (tinnitus) and fullness in one ear.

Central (brain) causes

Less commonly, vertigo comes from the brainstem or cerebellum. Causes include stroke or TIA affecting the back of the brain, multiple sclerosis and, rarely, tumors. These causes are less common but important not to miss.

Red Flags: When Dizziness Is an Emergency

Call 911 if dizziness or vertigo begins suddenly together with any of the following:

• Double vision or loss of vision.
• Slurred speech or trouble finding words.
• Weakness or numbness of the face, arm or leg.
• Inability to walk or severe loss of coordination.
• A sudden, severe headache.
• Fainting, chest pain or a racing heartbeat.

These can be signs of a stroke or a heart problem. Learn the BE FAST stroke warning signs.

How a Neurologist Evaluates Dizziness

The most important part of the evaluation is a careful history: what the dizziness feels like, how long it lasts, what triggers it and what other symptoms come with it. The examination includes checking eye movements, balance, coordination, strength, sensation and blood pressure lying and standing. Specific bedside tests can identify BPPV and help separate inner ear causes from brain causes.

Depending on the findings, your neurologist may recommend:

• Brain MRI when a central cause is suspected.
• Vascular studies, such as carotid and transcranial ultrasound, if circulation to the back of the brain is a concern.
• Hearing tests and vestibular testing, often with an audiologist or ear specialist.
• Heart evaluation if lightheadedness or fainting suggests a rhythm or blood pressure problem.
• Nerve testing when imbalance may be caused by peripheral neuropathy.

Treatment Options

Treatment depends on the cause:

• Repositioning maneuvers for BPPV, sometimes with exercises you can do at home.
• Vestibular rehabilitation therapy, a specialized form of physical therapy that retrains the brain to compensate for inner ear damage and improves balance.
• Migraine treatment, including lifestyle changes and preventive medication, for vestibular migraine.
• Short-term medications for nausea or severe spinning during acute attacks. These should be used only briefly, because long-term use can slow the brain's natural recovery.
• Medication review, since blood pressure medicines, sedatives and other drugs frequently contribute to dizziness, especially in older adults.
• Stroke prevention when vascular disease is the cause.

Dizziness in Older Adults

In older adults, dizziness and imbalance often have more than one cause at the same time: mild inner ear changes, reduced sensation in the feet, cataracts or changes in glasses, blood pressure that drops on standing and medications that add up. Each factor alone might be minor, but together they raise the risk of falls. A neurological evaluation looks at each contributor, because improving even two or three of them, such as adjusting a medication and starting balance therapy, can make walking noticeably safer.

Practical Tips for Living With Dizziness

• Get up slowly, sitting on the edge of the bed for a moment before standing.
• Use night lights and keep walkways clear to reduce fall risk.
• Stay hydrated, and be cautious with alcohol.
• Avoid driving or working at heights during active episodes.
• Keep a symptom diary to share with your doctor, noting duration and triggers.

Vertigo and Dizziness Care in Westwood, NJ

Vertigo and dizziness are among the clinical interests of Dr. Lorraine S. Lira. Our neurologists evaluate dizziness carefully to tell harmless causes from serious ones, and coordinate testing such as vascular ultrasound when needed. Review our neurology services or find directions on our contact page.

This article is for general education and does not replace advice from your own physician. If you think you are having a medical emergency, call 911.