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vertigo

 

Vertigo is a dizzy sensation where the world spins uncontrollably and is often accompanied by nausea and vomiting. The sensation is similar to acute sea-sickness or having drunk much too much alcohol. Vertigo in multiple sclerosis is usually accompanied by partial or complete loss of balance (vestibular ataxia) which is aggravated by fast turning movements. Vertigo is often most acute when the person is deprived of other senses especially sight, touch and proprioception (positional feedback from sensors all over the body).

Vertigo is a relatively common symptom of multiple sclerosis and can be caused by damage to the pons region of the brainstem where the acoustic cranial nerve (CN VIII) arises. CN VIII divides to serve both the acoustic and balance (vestibular) functions of the ear, and it is the balance portion of this nerve that is implicated in vertigo. Vertigo can also be caused by lesions in the cerebellum.

Other forms of dizziness, that are not described as vertigo, are also often associated with multiple sclerosis and usually involve dysfunction of the eyes muscles implying damage to cranial nerves III, IV and VI. Some of the drugs used to treat the specific symptoms of MS, such as Baclofen and tricyclic antidepressants can aggravate vertigo.

Vertigo is associated with several other conditions apart from multiple sclerosis, some of these are conditions are associated with dysfunction of the vestibular nerve and others are conditions of the balance organs in the inner ear.

Acute vertigo in multiple sclerosis usually remits gradually over a few weeks and it is rare for it to persist for a long period of time. However it often leaves a residue chronic dizzy sensation and a pronounced susceptibility to travel sickness.

Vertigo associated with damage to the vestibular nerve pathways is often much worse as you lie down in bed in the dark when the other senses are absent. The nausea and anxiety associated with a spinning world can make sleep very difficult. Placing dim lights around the house at night can help a little. Avoiding sudden head movements and using walls, lamp posts or a cane for guidance can ease navigation. Going around the house in bare feet can assist in the same way.

Drug treatments for vertigo include Antihistamines such as Dimenhydrinate (Benadryl), Meclizine (Antivert), Dramamine; cyclizine (Marezine); anti-emetic Phenothiazine derivatives such as Prochlorperazine (Compazine, Stemetil), Promethazine (Phenergan) or Chlorpromazine (Thorazine); anticholinergenic agents such as Scopolamine; Benzodiazepines such as Diazepam (Valium, Valrelease); and Benzamides such as Metoclopramide (Maxolon, Octamide PFS, Reglan). Some of these are more effective at dealing with nausea, others are better sedatives. Some have more serious side effects than others.

Vertigo Links:
Dizziness Explained
Dizziness and Vertigo
The dizzy patient
Evaluation of the Dizzy Patient 


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