•  The patient complains that his surroundings are spinning.
  •  The patient may suffer from vertigo due to peripheral causes (involving the inner ear) and central causes (underlying cause lies in the brain).
  •   May be associated with nausea and vomiting.
  • Some causes of peripheral vertigo:

  •   Benign Paroxysmal Positional Vertigo (BPPV): Vertigo associated with change of posture or head movements causing stimulation of the inner ear fluid by calcium crystals. Treatment consists of repositioning the crystals via manoeuvres such as Dix-Hallpike followed by Epley’s or the Semont’s manoeuvre.
  •   Meniere’s disease: Ménière’s is characterized by recurrent episodes of vertigo, fluctuating hearing loss and tinnitus. The patient may also present with associated aural fullness.
  •   Vestibulopathy: This occurs due to inflammation of the inner ear and may be unilateral/bilateral and acute/chronic.
  •   Vestibular paroxysmia: it manifests when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. A patient suffering from this may have multiple attacks of vertigo lasting less than a minute
  • Central vertigo may be due to:

  •  Vestibular schwannoma
  •   Stroke
  •   Multiple sclerosis
  •   Cerebellar infarction
  •   Vestibular migraines
  •   It is essential to diagnoses to cause of vertigo, and differentiate between its central or peripheral pathology. Treatment of the underlying cause allows relief.