Vertigo is a type of dizziness that you feel a sense of movement yourself or your surroundings. You have an illusion of movement- you feel yourself are spinning or your environtment are moving horizontally or vertically. The spinning often affects your balance. Vertigo and dizziness are not the same thing, but often use them interchangeably.

The problems in the brain and the inner ear can cause vertigo. An acute asymmetry or imbalance of neural activity between the left and right vestibular systems cause the most vertigo. A determination should also be mae as to whether the origin of vertigo- "peripheral or central".

Peripheral  Origin
The symptoms of peripheral origin are:

• Tinnitus or hearing lost.
• Accompanying nausea and vomiting.
• Uniderectional nsystagmus (may arise from either central or peripheral dsysfunction).

Central origin

• Diplopia, dysarthria, dysphagia or other symptoms of brainstem dysfunction.
• Vertical and direction-changing gaze-evoked nystagmus.

Benign Positional Paroxysmal vertigo (BPPV)

• The most common form of vertigo.
• Precipitated by changes in position ( turning over in bed or looking upward).
• The attack are brief (lasting seconds to minute), and occur most frequently when the individual is reclining in bed at night or upon awakening in the morning.
• Symptoms typically begin after a few seconds latency following the change in position and may be associated severe nausea and vomiting.
• May occur in clusters,with patients remaining asymptomatic for months or years in between

Patophysiology of BPPV

• Results from freely moving crystals of calcium carbonate within one of the semicircular canals.
• These crystals settle in the most dependent part of the canal (usually posterior) when the head is stationary.
• With head movements, the crystals move more slowly than the endolympg within which they lie, once the head comes to rest, their inertia causes ongoing stimulation of the hair cells,resulting in the illusion of movement (vertigo)

Diagnosis of BPPV
The Dix-Hallpike by demonstrating the characteristic downbeating and torsional nystagmus. Epley maneuver can be used to remove the crystals from the semicircular canal (posterior)

Treatment

• Prochlorperazine (for nausea and vomiting), the side effect of this is sleepy.
• Antihistamines (cinnarizine or cyclizine)
• Betahistine, physiotherapy and self-help advice can prevent attacks of vertigo.
• Betahistine increase blood flow around the inner ear.

(the doctor [rend-sand])