There are several disorders that cause a sudden very severe spell of vertigo. Usually this will be diagnosed as vestibular neuritis, a viral infection of the balance portion of the nerve to the inner ear that causes the nerve to shut down. A nerve can have sudden damage from a variety of other causes, and it can be easy (but dangerous) to overlook these.
A stroke is a loss of blood flow to the brain. If this affects the brainstem, the part of the brain that narrows as it transitions to the spinal cord, it can cause vertigo. This area takes information from the nerves feeding the inner ears and transmits that information to the balance part of the brain, the cerebellum. A loss of blood flow in the brainstem can cause damage to the nerve to the ear, just as is seen in vestibular neuritis, but also damages a part of the brainstem. The symptoms are very similar to vestibular neuritis, but the treatment is very different. Stroke treatment requires hospitalization and a workup to find the cause, things like narrowing of arteries, clotting problems, and other diseases of the arteries. Prompt treatment can reduce symptoms and allow recovery, while failure to treat can result in permanent disability and future strokes.
Wallenberg’s syndrome combines severe vertigo and profound balance problems with several other symptoms. It is caused by a stroke affecting the outer edge of the lower part of the brainstem, called the medulla, and so is also called lateral medullary syndrome. The arteries that feed this area are the vertebral arteries and a particular branch, the posterior inferior cerebellar artery (PICA), so the problem can be called PICA syndrome. The outcome is that the nerve to the ear on one side is damaged, but also the brain where the nerve enters, making the symptoms much worse.
It is easily misdiagnosed as vestibular neuritis because of the severe vertigo, vomiting and imbalance. If you examine a person with the problem, they have nystagmus, a drifting and jerking of the eyes. With a viral infection of the inner ear, a person will usually be able to walk with a little assistance. In Wallenberg syndrome, the person needs to have two people almost holding them up to walk. They will tend to tip and drift very strongly to one side and fall immediately if not supported. If they hold their arms out in front, the arms will also drift to one side as if being pulled.
There are some odd symptoms that help you know that the problem is coming from the brain and not just the inner ear. Most people report trouble swallowing that came on at the same time. Their voice might sound hoarse. Some have persistent hiccups. There is numbness of one side of the face. You can easily test for this by putting a cold spoon against the cheek and comparing it against the other cheek—it won’t feel cold on the side that has the stroke. There is numbness on the opposite side of the body, so if a spoon doesn’t feel cold on the left side of the face, for example, it will also not feel cold on the right arm or leg. This crossed pattern affecting the face and body is highly suggestive of a brainstem stroke.
If Wallenberg syndrome is suspected, the person should go to the hospital emergency department immediately. Treating quickly can help prevent the damage from becoming permanent. In our next posts we will talk about some other causes of vertigo that come from the brain.
Ending Vertigo Today 