Why does some vertigo take longer to recover?
Why does some vertigo take longer to recover?
By now, most of you reading this article would have had a sense of what vertigo is. Quite a few of us have experienced Benign Positional Paroxysmal Vertigo (BPPV). BPPV is one of the most common types of vertigo conditions that we experience due to the dislodgement of crystals. It is a biomechanical problem. Age is a major factor associated with it. It is about 40% more common in people over the age of 65 yrs even if they do not have any medical conditions.
A good thing about BPPV is that it can sort itself out or be resolved in a few sessions when treated by an experienced professional. In the end, it is pretty harmless although an awful feeling.
However 7%¹ of the people will experience a more severe form of vertigo, showing symptoms of dizziness, nausea, vomiting and/or imbalance which is generally difficult to manage at home. This very unpleasant vertigo episode is called Vestibular Neuritis (VN). This condition is often misdiagnosed in the emergency or by healthcare practitioners, as BPPV. Although misdiagnoses can occur, the benefit of going to emergency is that they can rule out something which can be fatal like strokes or other heart conditions.
Vestibular Neuritis (VN) is the third most common cause of peripheral vestibular vertigo. It has an annual incidence of 3.5 per 100,000 population.¹ First being BPPV and second is Vestibular migraine.
Let’s break this down into simpler terms- neuritis – inflammation of a nerve, VN is an inflammation of the vestibular nerve (cranial nerve no.8). You can get inflammation of any nerve in the body. If you have heard about Bell’s palsy, it is an inflammation of the Facial nerve (cranial nerve no. 7) which controls the movement of the face.
How can the nerve get inflamed?
It is thought that reactivation of a latent herpes simplex virus type 1 (HSV-1) infection is the most likely cause. These viruses have been found in the sections of the nerve. We all have these microorganisms residing in our bodies and they just need a trigger to reactivate. Upper respiratory chest infections or abdominal flu are also the contributors of this condition.
There are some bacterial causes as well, quite often a sinus or ear infection will trigger the episode. Most of the time we don’t even come to know that this virus has got activated. It just starts with the violent symptoms. Some factors can trigger this like stress, overwork, disturbed sleep, exhaustion, fatigue, cold and flu illness or other disorders that affect your immune system. I have encountered clients who had this when travelling by air or sea.
I would like to share a story about one of my recent clients. A kind, 61 year old, very active person. He was experiencing dizziness off and on for one month and he ignored the symptoms. In late May 2021 he experienced a violent attack of vertigo that included dizziness, nausea, vomiting and imbalance. His family was not able to manage his symptoms at home so they decided to take him to the Emergency. In the Emerg, blood work, CT scan and ECG were done, everything came normal. He was assessed by a neurologist and internal medicine specialist as he had a known heart condition. Stroke and tumours were ruled out. He was given anti-vomiting medication so that was controlled but his vertigo was not subsiding. Neurologists diagnosed him with BPPV and the hospital physio tried Epley’s manoeuvre but that didn’t work either. Consequently,I was called to the hospital to assess him. My detailed assessment showed a very specific pattern of nystagmus (eye movements). I confirmed my diagnosis as Acute Vestibular Neuritis on the left side.
We waited in the hospital for 3 hours in order to discuss the recommended medications with the doctor. Evidence has shown corticosteroids help in better outcomes by decreasing the swelling and inflammation in the nerve if given within a 24-72 hours period from the onset of the acute episode². This treatment is most often missed by a lot of healthcare practitioners due to a lack of awareness. We all know that this is an invisible injury so the impact is much more than what we think.
A similar inflammatory condition called Labyrinthitis affects the same nerve but it also affects the hearing. As there is hearing loss, it provides an additional clue and healthcare practitioners will typically give corticosteroids right away but not with Vestibular neuritis.
Due to my assessment, the gentleman was fortunate to get the Prednisone (steroid) treatment started right away and he is 80% better in one month with Acute Management and Vestibular Rehabilitation. Please refer to the articles below to present them to the doctors if you know someone who is experiencing those types of symptoms.
The vestibular therapy started on Day 4. This poor man was unsteady and dizzy but he persevered and positive results are showing. Now he can walk 45 minutes to 1hour independently at his favourite garden wherein at the time of the attack he was using a walker in the hospital. He is continuing to do his vestibular exercises. Typically it takes 6 weeks to sometimes many years to recover from it depending on the severity of the initial inflammation.
His recovery is progressing very well but in some cases there are some complications to the condition like a recurrence of BPPV and another condition called PPPD if the management of the symptoms is not taken care of on time. We will talk more about PPPD in our next blog. I would like to end by saying that we can beat the ill effects of Vestibular Neuritis by timely diagnosis and appropriate management. A simple way to beat this condition is having lifestyle changes that include less stress. Let me know if you would like to know more about any topics on Vestibular pathologies or rehab. I would be happy to write.
- Michael Strupp, Thomas Brandt. Vestibular neuritis. 2009 Nov;29(5):509-19.
- Sjögren, Julia; Magnusson, Måns; Tjernström, Fredrik; Karlberg, Mikael. Steroids for Acute Vestibular Neuronitis—the Earlier the Treatment, the Better the Outcome?Otology & Neurotology: March 2019 – Volume 40 – Issue 3 – p 372-374.