Systemic lupus erythematosus (SLE), commonly known as lupus, is a chronic autoimmune condition where the immune system mistakenly attacks healthy tissues and organs. This systemic inflammation can affect many parts of the body, including the skin, joints, kidneys, and the nervous system. Vertigo is a specific type of dizziness characterized by the sensation that you or your surroundings are spinning or whirling, often accompanied by nausea and unsteadiness. Given the inflammatory nature of lupus, it can potentially disrupt the balance system and cause vertigo.
Understanding the Link Between Lupus and Vertigo
Lupus can cause vertigo, although it is a less frequent manifestation compared to other symptoms. This connection falls under Neuropsychiatric Systemic Lupus Erythematosus (NPSLE), which describes symptoms arising from lupus activity in the brain, spinal cord, or peripheral nerves. Studies suggest that up to 70% of individuals with SLE may report issues with dizziness or hearing.
The underlying mechanism involves the immune system targeting structures essential for maintaining balance. This occurs through inflammation, direct antibody attack, or disruption of blood flow to the nerves and organs responsible for spatial orientation. Lupus-related vertigo is categorized as either central (affecting the brain) or peripheral (affecting the inner ear), with both resulting from autoimmune activity. The location of the damage dictates the symptoms and the necessary treatment approach.
How Lupus Affects the Central Nervous System and Balance
Central vertigo originates from damage to the brain, specifically the brainstem and cerebellum, which control balance and coordination. Lupus can trigger inflammation of the blood vessels in the brain, known as central nervous system (CNS) vasculitis. Vasculitis can restrict blood flow, leading to localized areas of reduced oxygen delivery, or ischemia, in these balance centers.
Ischemia in the brainstem or cerebellum disrupts the signaling pathways that process information from the inner ear, eyes, and muscles, manifesting as central vertigo. Lupus activity can also lead to the development of lesions or demyelination within the brain. These lesions interfere with the proper transmission of nerve signals, causing faulty communication between the balance organs and the brain. Functional imaging, such as SPECT scans, can sometimes reveal these perfusion abnormalities in the cerebellum.
Autoimmune Attack on the Inner Ear
Peripheral vertigo involves the inner ear, specifically the vestibular system, including the semicircular canals and the vestibulocochlear nerve (Cranial Nerve VIII). Lupus can directly attack these structures, leading to autoimmune inner ear disease (AIED). This attack is often mediated by autoantibodies or immune complexes that deposit in the microvessels.
Inflammation of the inner ear labyrinth, or labyrinthitis, can result from this immune assault, disrupting the fluid dynamics and sensory hair cells. Vasculitis in the tiny blood vessels supplying the inner ear is another mechanism, restricting blood flow and oxygen to the sensory organs. Damage to the vestibular system often results in sudden, severe episodes of spinning vertigo, sometimes accompanied by sensorineural hearing loss or tinnitus. The presence of antiphospholipid antibodies may also increase the risk of developing Meniere’s disease-like symptoms, including episodic vertigo and fluctuating hearing loss.
Identifying and Treating Lupus-Related Vertigo
Diagnosis begins with a comprehensive neurological and otological examination to rule out common causes, such as benign paroxysmal positional vertigo (BPPV) or migraines. Doctors look for specific signs, like involuntary eye movements (nystagmus), to distinguish between central and peripheral causes. Imaging tests, including MRI or CT scans, are employed to check for central nervous system involvement, such as lesions or signs of vasculitis in the brainstem.
Audiology tests, including pure-tone audiometry and electronystagmography, assess the function of the inner ear and vestibular nerve. Treatment focuses on managing the underlying autoimmune disease activity to reduce inflammation and prevent further damage. High-dose corticosteroids are used to quickly suppress the immune response during acute flares affecting the nervous system or inner ear. Immunosuppressive drugs, such as cyclophosphamide, may be employed for more severe cases to maintain long-term disease control. For persistent balance issues, symptomatic treatment includes vestibular rehabilitation therapy (VRT), which involves specialized exercises to retrain the brain to compensate for inner ear dysfunction.