Acute Vertigo: 3 Possible Causes

Did you wake up with vertigo? You are not alone. In this blog, we will discuss three possible causes of acute vertigo and what to do.

Is it an Emergency?

If you have acute vertigo, the first step is to decide if you need emergency care. You can contact your personal doctor to determine if your acute vertigo requires emergency care.

In this blog, I discuss criteria to go to an emergency room for vertigo care.

BPPV

The most common inner ear cause of vertigo is BPPV. This is a condition where calcium carbonate crystals become dislodged and displaced inside your inner ear.

Most people who wake up with vertigo in the middle of the night or in the morning have BPPV. People with acute vertigo who can find a position of relief and can still walk on their own may have BPPV.

Even so, certain subtypes of horizontal canal BPPV can be so intense and severe that many patients with this condition end up seeking emergency care during the acute stage.

If you feel vertigo when you lie down, roll over, sit up in bed, get out of bed, look up, look down, or bend over, then you may have BPPV. You can find use this blog to find a vertigo doctor to help with BPPV.

Viral Vertigo

If you have recently been exposed to a virus, then you may have viral vertigo. This condition can occur when a viral infection or inflammation can affect your inner ear and cause acute vertigo. Common preceding viruses include COVID, herpes (cold sores), GI bug, upper respiratory infection, and sinus infection.

• If hearing is affected, then the diagnosis is vestibular labyrinthitis.
• If hearing is not affected, then the diagnosis is vestibular neuritis.

If you have viral vertigo, then your acute vertigo may be continuous for 2-3 days. Viral vertigo is typically not easily relieved regardless of which position you are in, for the first few days.

Patients with viral vertigo may seek emergency care or urgent care to get medications for relief. Common medications prescribed for acute viral vertigo include steroids and antiviral medications.

I usually advise patients to sleep for the first few days of viral vertigo. Then they can consult with me for vestibular PT after the continuous acute vertigo has settled down, if needed.

To learn more about viral vertigo, click here.

Stroke in the Posterior Fossa

This is the most dangerous cause of acute vertigo. People with a stroke in the posterior fossa of their brain may initially have a clear CT scan at the emergency room. That is why follow up care is important if the cause of the acute vertigo is still a mystery.

Patients with a stroke in the posterior fossa may have continuous acute vertigo. Typically they will also have difficulty sitting up on their own and walking without assistance.

Most patients with BPPV or viral vertigo will feel off balance and apprehensive about falling, but they can still sit up and walk on their own. However, patients who cannot sit up or walk on their own should raise a red flag about a possible stroke in the posterior fossa.

If you cannot sit up on your own or walk on your own, you should seek emergency care. Even if the CT scan at the ER is clear, a prompt follow-up with your regular doctor and most likely a neurologist may be needed to diagnose or rule out a stroke.

The CT scan is notoriously limited in diagnosing this type of stroke, so an MRI or another type of vascular study with contrast may be superior for the diagnosis of any suspected posterior fossa stroke.

In these cases, a hands-on exam by a skilled provider who specializes in dizziness or vertigo may be superior to any brain CT scan or MRI in the acute stage. The practitioner would perform a HINTS+ exam to assess the cause of acute vertigo.

What Else Could it Be?

Episodic Vertigo Attacks

Other possible causes of acute vertigo include episodic conditions such as vestibular migraines and Ménière’s disease.

You can learn more about those two possible causes of acute episodes of vertigo with the following articles:

Vestibular migraines

Ménière’s disease