Why does rotation make the brain dizzy

Disease picture dizziness

  • The key to diagnosing the key symptom of dizziness is a careful history and physical examination, as the diagnostic criteria for most vertigo syndromes are based on this information. Apparatus diagnostics are usually of secondary importance.
  • Important criteria to differentiate between the various vertigo syndromes are:
    • Type of vertigo: vertigo, vertigo or vertigo
    • Duration of vertigo: attacks of vertigo or persistent vertigo
    • Triggerability / intensification of dizziness: already resting (e.g. vestibular neuritis), walking (e.g. bilateral vestibulopathy)
    • possible accompanying symptoms

Central vertigo:

Clinical signs of a central disorder in acute vertigo are vertical divergence ("skew deviation"), gaze nystagmus opposite to the direction of spontaneous nystagmus, gaze saccade, fixation nystagmus (nystagmus cannot be suppressed by visual fixation) and in acute nystagmus a normal head impulse test Differentiation between central and peripheral vertigo syndromes is possible in over 90% of patients.

Benign peripheral paroxysmal positional vertigo (BPPV):

BPPV is defined as an attack-like position-dependent vertigo with recurrent attacks of vertigo that last for seconds, with or without nausea and oscillopsia, triggered by changing the head position compared to gravity. There must be no evidence of central disorders (especially brain stem or cerebellar signs).

Symptoms often appear in the early hours of the morning. Repeated changes of position lead to a temporary weakening of the attacks. Typical triggers are: lying down or straightening up in bed, turning around in bed, especially to the side of the affected ear, bending over and / or reclining the head.

Acute vestibular neuritis: Acute / subacute onset, for days to a few weeks, severe permanent vertigo with oscillopsia (wobbly images), unsteadiness and unsteadiness with a directed tendency to fall, as well as nausea and vomiting. Findings: horizontally rotating peripheral vestibular spontaneous nystagmus, which can be suppressed by visual fixation, pathological head impulse test.


Monotherapy with glucocorticoids (start of treatment within 3 days of the onset of symptoms, e.g. with 100 mg methylprednisolone per day, reduce the dose by 20 mg every fourth day) significantly improves the recovery of peripheral vestibular function. Targeted balance training accelerates and improves the central vestibular compensation of the tone imbalance between the intact and failed labyrinth.

Bilateral vestibulopathy: Movement-dependent vertigo and unsteady gait, intensified in the dark and on uneven surfaces, as well as oscillopsia with rapid head movements and when walking. Findings: pathological head impulse test on both sides and / or low or low caloric excitability


Since ototoxic substances and bilateral Menière's disease are the two most common causes of bilateral vestibulopathy, prophylaxis through strict indications for ototoxic antibiotics and prophylactic treatment of Menière's disease are the most important treatment measures. Physiotherapy in the form of intensive balance training and gait training has a therapeutic effect.

Meniere's disease: Triassic attacks with vertigo and unilateral hearing loss (mostly low-pitched hearing loss), tinnitus and a feeling of pressure in the ears


Prophylactic treatment of attacks: A high-dose and long-term treatment with betahistine dihydrochloride (3 × 48 mg per day for 12 months) significantly reduces the number of attacks and is more effective than a lower dose (3 × 16 to 3 × 24 mg per day) and shorter treatment (3–6 months.

Local transtympanic instillation of 10–20 mg gentamicin is also effective prophylactically, with the application being carried out at intervals of several weeks so that there is no pronounced toxic damage to the inner ear. The transtympanic administration of steroids also has a prophylactic effect.

Vestibular paroxysmia: recurrent, short, usually only seconds, rarely lasting up to minutes lasting vertigo attacks (rarely vertigo).

therapy Carbamazepine or oxcarbazepine are the preferred prophylactic treatment for short-term vertigo attacks.

Vestibular migraines: recurrent attacks of vertigo, usually lasting several minutes to hours, with (about 60% of patients) or without symptoms typical of migraine.


There are still no controlled studies on the specific therapy available. A retrospective study showed a significant reduction in the frequency and severity of attacks under medical migraine prophylaxis, so that vestibular migraines should be treated like migraines with aura until specific therapeutic studies are available.

Phobic vertigo: Context-dependent vertigo and dizziness.


Combined drug and behavioral therapy is effective, although there are still no randomized, controlled studies. Comorbidities and earlier phases of psychiatric illness are of great importance for the occurrence of secondary somatoform vertigo.