Introduction

Vertiginous syndrome, also known as dizziness, is a common symptom that can be caused by various underlying conditions. It is characterized by a sensation of spinning or unsteadiness, often accompanied by nausea, vomiting, and difficulty maintaining balance^[1]. The aim of this guide is to provide healthcare professionals with a comprehensive overview of the diagnostic steps, possible interventions, and patient education for vertiginous syndrome.

Codes

• ICPC-2 Code: H82 Vertiginous syndrome^[2]


• ICD-10 Code: H81 Disorders of vestibular function^[3]

Symptoms

• Vertigo: A spinning or whirling sensation, often described as feeling like the room is spinning^[4].


• Nausea and vomiting: Feeling sick to the stomach and vomiting^[5].


• Imbalance and unsteadiness: Difficulty maintaining balance and coordination^[6].


• Tinnitus: Ringing or buzzing in the ears^[7].


• Hearing loss: Partial or complete loss of hearing^[8].

Causes

• Benign paroxysmal positional vertigo (BPPV): Dislodged calcium crystals in the inner ear^[9].


• Meniere’s disease: Buildup of fluid in the inner ear^[10].


• Vestibular neuritis: Inflammation of the vestibular nerve.


• Labyrinthitis: Inflammation of the inner ear.


• Migraine-associated vertigo: Vertigo associated with migraines.


• Medications: Certain medications can cause vertigo as a side effect.


• Other causes: Head injury, stroke, tumors, and other neurological conditions.

Diagnostic Steps

Medical History

• Gather information about the onset, duration, and frequency of vertigo episodes.


• Ask about associated symptoms such as nausea, vomiting, hearing loss, or tinnitus.


• Inquire about any recent head injuries, infections, or changes in medication.


• Assess for any risk factors such as a family history of vertigo or migraines.

Physical Examination

• Perform a comprehensive physical examination, including a neurological examination.


• Assess for any signs of nystagmus (involuntary eye movements) or abnormal eye movements.


• Evaluate balance and coordination through various tests, such as the Romberg test.


• Check for any abnormalities in the ear, such as redness, swelling, or discharge.

Laboratory Tests

• Complete blood count (CBC): To rule out anemia or infection.


• Thyroid function tests: To assess thyroid function, as thyroid disorders can cause vertigo.


• Blood glucose levels: To rule out hypoglycemia, which can cause dizziness.


• Lipid profile: To assess cholesterol levels, as high cholesterol can increase the risk of vertigo.


• Electrolyte levels: To check for any imbalances that may contribute to vertigo.

Diagnostic Imaging

• Magnetic resonance imaging (MRI): To visualize the brain and inner ear structures.


• Computed tomography (CT) scan: To assess for any structural abnormalities or tumors.


• Electronystagmography (ENG): To evaluate eye movements during positional changes.


• Videonystagmography (VNG): To assess eye movements using video recording.


• Audiometry: To evaluate hearing loss and assess the function of the inner ear.

Other Tests

• Dix-Hallpike maneuver: A positional test used to diagnose benign paroxysmal positional vertigo (BPPV).


• Caloric testing: A test that involves irrigating the ear canal with warm or cold water to assess vestibular function.


• Posturography: A test that measures balance and stability using a force platform.


• Vestibular evoked myogenic potentials (VEMP): A test that assesses the function of the otolithic organs in the inner ear.

Follow-up and Patient Education

• Schedule follow-up appointments to monitor the effectiveness of interventions and adjust treatment if necessary.


• Provide patient education on the underlying cause of vertigo and the importance of adherence to treatment.


• Educate patients on lifestyle modifications and strategies to manage vertigo episodes, such as avoiding triggers and maintaining a healthy diet and exercise routine.


• Encourage patients to seek medical attention if symptoms worsen or new symptoms develop.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Vertiginous syndrome:

1. Meclizine (Antivert):
   
   
   
   • Cost: $10-$30 for a month’s supply.
   
   
   • Contraindications: Hypersensitivity to meclizine or related medications.
   
   
   • Side effects: Drowsiness, dry mouth, blurred vision.
   
   
   • Severe side effects: Irregular heartbeat, difficulty urinating.
   
   
   • Drug interactions: Alcohol, sedatives, tranquilizers.
   
   
   • Warning: May cause drowsiness, avoid driving or operating machinery.
   
   
   
   


2. Betahistine (Serc):
   
   
   
   • Cost: $20-$50 for a month’s supply.
   
   
   • Contraindications: Pheochromocytoma, bronchial asthma.
   
   
   • Side effects: Upset stomach, headache, dizziness.
   
   
   • Severe side effects: Allergic reactions, low blood pressure.
   
   
   • Drug interactions: None reported.
   
   
   • Warning: Use with caution in patients with peptic ulcers or asthma.
   
   
   
   


3. Dimenhydrinate (Dramamine):
   
   
   
   • Cost: $5-$15 for a month’s supply.
   
   
   • Contraindications: Asthma, narrow-angle glaucoma.
   
   
   • Side effects: Drowsiness, dry mouth, blurred vision.
   
   
   • Severe side effects: Irregular heartbeat, difficulty urinating.
   
   
   • Drug interactions: Alcohol, sedatives, tranquilizers.
   
   
   • Warning: May cause drowsiness, avoid driving or operating machinery.
   
   
   
   


4. Scopolamine (Transderm Scop):
   
   
   
   • Cost: $30-$60 for a month’s supply.
   
   
   • Contraindications: Glaucoma, urinary retention.
   
   
   • Side effects: Dry mouth, blurred vision, drowsiness.
   
   
   • Severe side effects: Rapid heartbeat, hallucinations.
   
   
   • Drug interactions: Alcohol, sedatives, tranquilizers.
   
   
   • Warning: Apply the patch behind the ear at least 4 hours before the desired effect.
   
   
   
   


5. Diazepam (Valium):
   
   
   
   • Cost: $10-$30 for a month’s supply.
   
   
   • Contraindications: Severe respiratory insufficiency, sleep apnea.
   
   
   • Side effects: Drowsiness, dizziness, confusion.
   
   
   • Severe side effects: Respiratory depression, dependence.
   
   
   • Drug interactions: Alcohol, sedatives, tranquilizers.
   
   
   • Warning: May cause drowsiness, avoid driving or operating machinery.
   
   
   
   

Alternative Drugs:

• Ginger (Zingiber officinale): Known for its antiemetic properties, ginger can help alleviate nausea associated with vertigo. Cost: $5-$10 for a month’s supply.


• Vitamin B6 (Pyridoxine): Some studies suggest that vitamin B6 may help reduce the frequency and severity of vertigo episodes. Cost: $5-$10 for a month’s supply.


• Ginkgo biloba: This herbal supplement may improve blood flow to the brain and inner ear, potentially reducing vertigo symptoms. Cost: $10-$20 for a month’s supply.


• Valerian root (Valeriana officinalis): Valerian root has calming properties and may help reduce anxiety associated with vertigo. Cost: $5-$10 for a month’s supply.


• Melatonin: Melatonin can help regulate sleep patterns and may be beneficial for patients with vertigo-related sleep disturbances. Cost: $5-$10 for a month’s supply.

Surgical Procedures:

• Vestibular rehabilitation therapy (VRT): A specialized form of physical therapy that aims to improve balance and reduce vertigo symptoms through exercises and maneuvers. Cost: $100-$200 per session.


• Endolymphatic sac decompression: A surgical procedure that involves removing a small piece of bone to relieve pressure in the inner ear. Cost: $5,000-$10,000.


• Labyrinthectomy: A procedure to remove the entire inner ear to eliminate vertigo symptoms. Cost: $10,000-$20,000.


• Vestibular nerve section: A surgical procedure that involves cutting the vestibular nerve to eliminate vertigo symptoms. Cost: $10,000-$20,000.


• Cochlear implant: In cases where severe hearing loss is present, a cochlear implant may be considered to improve hearing and reduce vertigo symptoms. Cost: $50,000-$100,000.

Alternative Interventions

• Acupuncture: May help alleviate vertigo symptoms by promoting blood flow and reducing inflammation. Cost: $60-$120 per session.


• Chiropractic care: Some patients report improvement in vertigo symptoms with chiropractic adjustments. Cost: $50-$100 per session.


• Herbal supplements: Certain herbs, such as ginger and ginkgo biloba, have been used traditionally to alleviate vertigo symptoms. Cost: Varies depending on the specific supplement.


• Yoga and meditation: These mind-body practices can help reduce stress and improve overall well-being, potentially reducing vertigo symptoms. Cost: $10-$20 per class.