What is Central Vertigo?

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Introduction

Central vertigo is a type of dizziness caused by problems within the brain. Specifically, central vertigo usually results from problems at the cerebellum (which controls balance and coordination), brainstem (which connects the brain to the spinal cord), or higher cortical centers of the brain.

Central vertigo is complex, may come with other neurological symptoms, and usually results in vertigo that is constant. It can be exacerbated by positional changes, but is usually present even when you are still.

Common Causes of Central Vertigo

Central vertigo can be caused by several conditions:

• Stroke or Transient Ischemic Attack (TIA)

• Multiple Sclerosis (MS)

• Parkinson’s Disease

• Brain tumors (rare)

• Migraine-related vertigo (Vestibular Migraine)

• Head injuries including concussion and TBI

• Infections or inflammation affecting the brain

• Autoimmune pathology

Symptoms of Central Vertigo

People with central vertigo may experience:

• A spinning or tilting sensation that is constant

• Imbalance or difficulty walking in a straight line (feeling like the room is tilting or moving)

• Double vision or and a lack of depth perception

• Coordination impairment and motor weakness

• Slurred speech

• Headaches and migraines

Diagnosis

A doctor or neurologist may recommend:

• A neurological exam to check balance, coordination, eye movements, and reflexes

• Imaging tests (MRI or CT scan) to look for changes in the brain

• Blood tests or other evaluations depending on suspected cause

Treatment Options

The treatment for central vertigo depends on the underlying condition:

• Central vertigo is often treated by a team of medical professionals which often includes: a Neurologist, a Neuro-opthalmologist, a Physical Therapist specializing in vestibular disorders, and a Speech Therapist.

  • Neurologist:

    • often prescribe medication to control nausea, dizziness, or migraines/headaches as needed

    • order imaging of the brain and spinal cord for proper diagnosis and medical management

  • Neuro-ophthalmologist:

    • perform an eye exam that assesses eye movement (different from a typical eye exam)

    • can prescribe lenses for an impairment with convergence, divergence, and oscillopsia that help with depth perception and a tilting or moving world

  • Vestibular Rehabilitation Physical Therapist:

    • prescribes exercises to retrain the brain, improve eye movement, improve balance, decrease dizziness, and improve coordination and motor control

    • help manage headaches, migraines, and vestibular migraines

  • Speech/Cognitive Therapist:

    • help to regain normal speech for individuals that have slurred speech post brain injury

    • help individuals with cognitive impairment improve executive brain function (planning and coping strategies to help individuals accomplish tasks throughout the day without overstimulating the brain)

What is Peripheral Vertigo?

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Introduction

Have you ever felt like the room was spinning even though you were standing still? Sometimes the spinning sensation only last seconds, and other times it can last minutes, hours, or even days depending on the the type of vertigo and the cause of the vestibular symptoms. Peripheral vertigo indicates that the dizziness comes from problems in the inner ear, the part of your body that helps control balance and can be described as your internal gyroscope. While it can feel alarming, the good news is that peripheral vertigo is often treatable with the right care.

What Is Peripheral Vertigo?

Your inner ear (vestibular organ) sends signals back to your eyes and brain about positional changes that are occurring (ie: getting up and down out of bed, bending forward, turning the head up/down and R/L). Vertigo results when signals from your inner ear get disrupted. Your brain receives confusing messages which leads to dizziness, spinning sensations, and balance problems.

Common Causes

Several inner ear conditions can trigger peripheral vertigo:

• Benign Paroxysmal Positional Vertigo (BPPV): caused by tiny crystals in the inner ear that move into the wrong spot

• Vestibular Neuritis: inflammation of the vestibular nerve, often after a viral infection

• Ménière’s Disease: a condition with fluid buildup in the inner ear, leading to vertigo, hearing changes, and ringing in the ears

• Labyrinthitis: viral infection that results in dizziness and an acute loss of hearing

• Eustachian Tube Dysfunction and Sinus related Dizziness: a fluid imbalance in the inner ear that results in instability and poor balance, but usually does not produce true room spinning dizziness

Symptoms to Watch For

People with peripheral vertigo may notice:

• Sudden spinning or dizziness, often triggered by laying flat, bending forward, quick head changes

• Nausea or vomiting

• Trouble keeping balance (often requires a couple of min to orient themselves in the AM or when first getting up from laying flat)

• Sensitivity to head motion

• In some cases, ringing in the ears or changes in hearing

How is Peripheral Vertigo Diagnosed?

A healthcare professional may use:

• A balance exam and VOR testing

• The Dix-Hallpike maneuver to check for BPPV

• Hearing assessments or medical imaging, depending on symptoms

• VNG (performed by an ENT)

Treatment Options

The best treatment depends on the underlying cause, but common approaches are:

• Vestibular Rehabilitation Therapy (VRT): special exercises guided by a physical therapist to retrain balance and reduce dizziness

• Canalith Repositioning Maneuvers: for BPPV, techniques such as the Epley maneuver help move misplaced inner ear crystals back where they belong

• Medication: sometimes prescribed to ease nausea, reduce inflammation, manage viruses, and manage fluid and pressure build up in the ears

• Lifestyle Adjustments: limiting salt and caffeine intake and avoiding sudden head movements may help manage symptoms

How Physical Therapy Helps

At Mind Body Balance Physical Therapy PLLC, we specialize in vestibular rehabilitation. Our therapists design individualized programs that may include:

• Balance training to reduce fall risk

• Gaze stabilization exercises to improve vision control during movement

• Step-by-step repositioning maneuvers for BPPV

• Education to give you tools for managing dizziness in daily life

With consistent therapy, many patients notice a significant decrease in dizziness and are able to return to normal activities.

Maintaining Balance for the Elderly

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As we age, maintaining balance becomes increasingly crucial for preserving independence. Falls can lead to debilitating injuries and affect your mobility and wellness. The risk of falls rises as we age for a few reasons which we will discuss as well as intervention and treatment strategies to combat the effects of aging.

• What factors make us balanced?

  Balance is a complex interplay of sensory input from our ears, eyes, and proprioceptors found in all of our joints. As we age, changes in vision, proprioception, and vestibular function can compromise balance, making older adults more susceptible to falls. Factors that affect our visual acuity include cataracts and changing prescriptions. Proprioception is affected by decreased mobility in the joints from osteoarthritis and postural changes. Changes in inner ear function result from hearing loss and vestibular weakness. Additionally, age-related declines in muscle mass and bone density can further exacerbate the risk of falls and injuries.

• How can we take care of our vision and hearing?

  See your ophthalmologist and audiologist for regular checks to maintain your eye prescription and maintain your ability to hear. Corrective measures, such as eyeglasses or hearing aids, can improve sensory input and enhance balance. Maintaining good hearing keeps you cognitively sharp; dont let your world get quiet.

• How can we keep our inner ears and vestibular system strong?

  Perform balance related activity like standing in tandem or standing on one leg. When balancing on a stable surface becomes easy transition to standing on a pillow or unstable surface. Once standing on unstable surfaces gets easier head turns up and down and R/L can be added. Walk forwards, backwards, and side to side. Move with exaggerated movement patterns including marching while you walk and rocking from your heels to your toes.

• How can we combat muscle weakness and impaired mobility?

  Strength and balance exercises tailored to the needs of older adults can help improve muscle strength, coordination, and flexibility, thereby enhancing mobility. If our joints maintain their mobility, proprioception can be maintianed and reduce the risk of falls.

• How important is medication management?

  Certain medications, especially those affecting heart rate and blood pressure, can increase the risk of falls resulting from orthostatic changes. Regular medication reviews with healthcare providers can help identify and mitigate the adverse effects of medications on balance. If you know that standing up quickly results in light headedness spend 1-2 min in sitting before standing. While sitting performing seated calf raises and extending the knees can be advised to get blood up to the head and heart and increase BP.

• What are some common environmental hazards?

  Removing hazards in the home environment, such as loose rugs can be helpful. Make sure all areas are well lit (do not get up to go to the bathroom at night in the dark; remember the eyes are crucial for balance). Most falls happen in the bathroom and kitchen, because of the tight space and quick turns that happen in these areas; installing grab bars in bathrooms can enhance safety and prevent accidents.

• Do exercise programs help?

  Participating in evidence-based exercise programs, such as Tai Chi, yoga, or group strength and balance classes, can improve strength, flexibility, and balance, reducing the likelihood of falls.

In conclusion, restoring balance and reducing falls among the elderly population requires a multifaceted approach that addresses both modifiable risk factors and proactive interventions. By promoting strength and mobility, minimizing environmental hazards, and implementing targeted fall prevention strategies, older adults can maintain their independence and quality of life while reducing the risk of falls and related injuries.