Vertigo

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Vertigo is a symptom where a person feels as if they or objects around them are moving when they are not. It is often a spinning or swaying movement. A person may experience nausea, vomiting, sweating, or difficulties walking. It is usually worse when the head is moved.

Benign paroxysmal positional vertigo (BPPV) is where specific head movements cause vertigo – is the most common type of vertigo.[1]

Prevalence[edit | edit source]

According to the Canadian Consensus Criteria, Vertigo only occasionally affects ME/CFS patients.[2]

Vertigo in ME/CFS[edit | edit source]

Vertigo is not commonly experienced by ME/CFS patients (although possible as neurological problems in general are a prominent feature of ME/CFS). Dizziness is a far more common symptom of ME/CFS, and is usually due to Postural orthostatic tachycardia syndrome (POTS) or other forms of orthostatic intolerance.[3][2] [4] which are prominent co-morbid symptoms and just two of the [:Category:Cardiac_signs_and_symptoms |cardiac signs and symptoms]] they can experience.

Symptom recognition[edit | edit source]

The Canadian Consensus Criteria recognizes vertigo occuring within ME/CFS, although vertigo is not a diagnostic symptom of ME/CFS:

"Vertigo accompanied by nystagmus, nausea and/or vomiting and often associated with tinnitus and/or impaired hearing acuity requires an anti-nauseant but there is no good treatment."[2]:60

Possible causes[edit | edit source]

General causes for vertigo include:

Certain drugs can also cause vertigo, this should be listed as a side effect on the patient information (PI) leaflet.[1]

Tests[edit | edit source]

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In our Vestibular Tests Video Series, Kristen Janky, Au.D, Ph.D., CCC-A, Vestibular Audiologist at Boys Town National Research Hospital, explains the VNG test. By BoysTownHospital

Videonystagmography (VNG eng testing) is used for testing inner ear and central motor functions.[5]

There are 4 main parts to a VNG test:

1. Occular Mobility 

You will be asked to have your eyes follow objects that jump from place to place, stand still, or move smoothly. The technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

2. Optokinetic Nystagmus

2. You will be asked to view a large, continuously moving visual image to see if your eyes can appropriately track these movements. Like the occular mobility tests, the technician will be looking for any slowness or inaccuracies in your ability to follow visual targets. This may indicate a central or neurological problem, or possibly a problem in the pathway connecting the vestibular system to the brain.

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Vestibular Tests - Roll Test (Positional Nystagmus): The maneuver we can use to assess for horizontal canal BPPV is called the Roll Test. For this maneuver the patient starts sitting up and then they will lay straight back and you will hold their head at a 30 degree angle. For more information on our Balance and Vestibular. By BoysTownHospital

3. Positional Nystagmus 

The technician will move your head and body into various positions to make sure that there are no inappropriate eye movements (nystagmus), when your head is in different positions. This test is looking at your inner ear system and the condition of the endolymph fluid in your semi-circular canals. The technician is verifying that small calcium carbonate particles called otoconia are not suspended in the fluid and causing a disturbance to the flow of the fluid.

4. Caloric Testing 

The technician will stimulate both of your inner ears (one at a time) with warm and then cold air. They will be monitoring the movements of your eyes using goggles to make sure that both of your ears can sense this stimulation. This test will confirm that your vestibular system for each ear is working and responding to stimulation. This test in the only test available that can decipher between a unilateral and bilateral loss.[5]

Potential treatments[edit | edit source]

Meclozine is a suggested treatment for vertigo, it is acts against nausea and is also an antihistamine.[2]

The Canadian Consensus Criteria is suggests "Finding Center" for balance issues (Jones and Clarke, 2002) and the Cawthorne/Cooksey System for vistibular injuries to restore equilibrium.[2]

Notable studies[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 https://www.nhs.uk/conditions/vertigo/
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003). "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF). Journal of Chronic Fatigue Syndrome. 11 (2): 7–115. doi:10.1300/J092v11n01_02.
  3. ↑ "Symptoms | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. January 27, 2021. Retrieved February 25, 2021.
  4. ↑ Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  5. ↑ 5.0 5.1 "Videonystagmography | National Dizzy and Balance Center | NDBC". nationaldizzyandbalancecenter.com. Retrieved January 21, 2019.
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