This document discusses vertigo and disequilibrium. It defines vertigo as a spinning sensation when one feels they or objects around them are moving when they are not. Vertigo can be caused by problems in the inner ear or brain. The two main types are peripheral vertigo, caused by issues in the inner ear or vestibular nerve, and central vertigo, caused by problems in the brain like the cerebellum. Common causes of peripheral vertigo include BPPV, Meniere's disease, and acute peripheral vestibulopathy. Central vertigo may be caused by conditions like stroke, tumors, or multiple sclerosis. Symptoms, tests, treatments, and the affected nervous system parts are described for both

1. Vertigo and Disequilibrium
Final project for Coursera (MOOC)
Understanding the Brain- the
Nuerobiology Of Everyday
University of Chicago
By JHANVI SOLANKI

2. Brief Introduction:
What do you mean
by VERTIGO?
Vertigo or Ataxia can be defined as a spinning
sensation when you feel: you or the things around you
are moving when they are not. The individual has an
impaired function for detection of angular
concentration.
Vertigo can be due to many underlying causes, such
as inner ear problems where the semicircular canals
do not work properly (benign) to serious conditions
like tumours.
The symptoms mainly involve Faintness,
lightheadedness, imbalance, floating sensation and
motion intolerance. The individual can have vertigo
attacks on a range of twice or thrice a week or once a
year.

3. Causes of Vertigo 1. Central Vertigo: occurs due to a
problem in the brain, particularly
cerebellum. Since cerebellum
controls coordination of
movements and balance, vertigo
associated diseases occur in the
individual.
2. Peripheral Vertigo: occurs as a
result of problems in the inner ear
or vestibular nerve. The vestibular
nerve is responsible for
connecting the inner ear to the
brain.
Central Vertigo Peripheral Vertigo

4. Conditions seen in the 2 types of Vertigo:
Peripheral Vertigo:
Statistics say, Peripheral Vertigo is more
common and seen in 93% of people.
Caused by:
● Benign Paroxysmal Positional Vertigo (BPPV)
- positional changes leading to vertigo due to
calcium crystals floating in semicircular
canals of the ear.
● Meniere's Disease - inner ear disorder that
affects hearing ability and balance both.
● Acute peripheral vestibulopathy -
inflammation of inner ear causing vertigo.
Central Vertigo:
It is due to a problem in a part of the
hindbrain, commonly in cerebellum.
Caused by:
● Stroke
● Tumours
● Migraine
● Multiple sclerosis (acute demyelination)
● Blood vessel disease
● Vestibular headache - a type of migraine
headache
● Seizures - rarely

5. Symptoms of Vertigo-associated disease
(Common symptoms- spinning sensation, nausea, vomiting)
Peripheral Vertigo
● Problem focussing the eyes
● Dizziness
● Loss of Balance
● Hearing loss in one ear
● Ringing in the ears
● Nausea and vomiting leading to
loss of body fluids
Central Vertigo:
● Eye movement problems
● Dizziness
● Double Vision
● Slurred speech
● Facial Paralysis
● Weakness of the limbs

6. Diagnosis and Tests for the Vertigo-associated
diseaseThe diagnosis depends on whether:
1. You have true vertigo or mild dizziness
2. The cause i.e. peripheral or central
3. If any life threatening complications are present
determined by warning signs include-
● sudden vertigo not affected by change of position
● vertigo associated with neurological signs such as
severe lack of muscle coordination or new weakness
● vertigo associated with deafness and no history of
Meniere’s disease
1. History-taking and asking questions
● duration of illness
● duration of episodes or attacks
● triggers
● associated symptoms
Tests that determine the type of Vertigo:
● Head-thrust test: You look at the examiner’s nose,
and the examiner makes a quick head movement to
the side and looks for correct eye movement.
● Romberg test: You stand with feet together and eyes
open, then close your eyes and try to maintain
balance.
● Fukuda-Unterberger test: You’re asked to march in
place with your eyes closed without leaning from
side to side.
● Dix-Hallpike test: While on an examination table,
you’re quickly lowered from a seated position to a
supine position with your head pointed either slightly
right or slightly left. A doctor will look at your eye
movements to learn more about your vertigo.

7. Treatment of
Vertigo-associated
disease
● For BPPV, Epley Maneuver - placing the head in different positions to regain balance.
● For peripheral vertigo, medicines to treat nausea and vomiting
● Commonly used medicines- Vestibular blocking agents like
1) Antihistamines 2) Benzodiazepines 3) Antiemetics
● Physical therapy and exercise to improve balance problems
● To prevent worsening of symptoms, the patient should sit still and resume activities slowly;
the individual should not read when the symptoms occur and should avoid bright lights.
● Symptom-wise treatment involve advising bed rest, vestibular blocking agents for acute
vertigo attacks and acute peripheral vestibulopathy. Antiemetic and Diuretic medications
along with bed rest and Vestibular blocking agents advised for patients with Meniere’s
disease.

8. Risk factors due to
vertigo and related
diseases
The chances of these diseases
increase due to the presence of
vertigo conditions:
● Cardiovascular diseases
● Recent ear infection causing
imbalance in the ear
● History of head trauma
● Medications such as antidepressants
and antipsychotics
● Meniere’s disease has no cure so only
the symptoms can be managed
● Acute Peripheral lasting for 24 to 48
hours

9. Which parts of nervous system are active and affected during vertigo?
Central Vertigo and Peripheral Vertigo involve impaired function of certain parts of CNS (Central nervous system)
and peripheral vestibular system from inner ear to vestibular division of the cranial nerve VIIIth (vestibulocochlear
nerve) respectively.
Central Vertigo occurs due to the dysfunction of vestibular structures in CNS, occurring when there is a lesion of
brainstem vestibular apparatus. It is most commonly a result of ischaemia of central vestibular structures in the
cerebellum, brainstem or vestibular nuclei, along with vascular risk factors. In the case of tumours, posterior brain
fossa is affected.
Peripheral Vertigo occurs when there is a problem in the peripheral vestibular system, which comprises of the
saccule, utricle and semicircular canals that have a suppressed visual fixation. The peripheral vestibular
apparatus projects neuroepithelial hair cells to medulla and pons via the VIIIth cranial nerve, extending to
cerebellum, extraocular nuclei and spinal cord.
The maintenance of visual fixation is maintained by the normal functioning of oculomotor central neural integrator
consisting of medial vestibular nucleus and nucleus prepositus hypoglossi through the vestibulo-ocular reflex with
changing head and body positions during movements. Hence, any lesion in these results into vertigo and
associated signs of nystagmus.

10. REFERENCES
● Ochsner J. 2009 Spring; 9(1): 20–26, Timothy L. Thompson, MD and
Ronald Amedee, MD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096243/
● Nancy Choi, MD , Lydia Krause, September 23, 2019
https://www.healthline.com/health/vertigo#causes
● Forshing Lui; Lisa A. Foris; Keith Willner; Prasanna Tadi, July 6, 2020
https://www.ncbi.nlm.nih.gov/books/NBK441861/

11. UNDERSTANDING NEUROBIOLOGY IN EVERYDAY LIFE - THANKING YOU!
This interesting and immensely valuable course has made me discover a
profound liking towards neurobiology, and the world of neuroscience.
My undergraduate background is in dentistry and this course allowed me to
gain an entirely new perspective towards my interests and a driven passion
about neuroscience. The teachings by PROF. PEGGY MASON made me realise
how it is everywhere, and explains all the everyday events around us.
My favorite lesson is about Neuroanatomy and the voluntary movements. It
makes one understand better about the control of brain through neurons for
every action of ours. I have chosen this topic as the final project as I have
closely observed how things turn around in a person experiencing vertigo
attacks as my mom has the condition. Personally, this course has made me
want to proceed my further studies in this area.
Absolutely thrilled to have been a part of this, and getting a chance to study
Neurobiology on this platform.