Vertigo is a specific sensation of spinning, where a person feels either they are moving or the world around them is revolving. This is distinct from general dizziness, which is a broader term encompassing lightheadedness, faintness, or a feeling of unsteadiness. True vertigo originates from a disruption in the vestibular system, the body’s balance mechanism located in the inner ear and brain. While the question of a cancer link is understandable, malignancy is an extremely infrequent cause of vertigo. The vast majority of cases result from non-life-threatening inner ear conditions.
Understanding Common Causes of Vertigo
Most instances of vertigo are classified as peripheral, meaning the problem lies within the inner ear’s labyrinth or the vestibular nerve connecting it to the brain. Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause, characterized by brief, intense episodes of spinning triggered by specific head movements, such as rolling over in bed or looking up. BPPV occurs when tiny calcium carbonate crystals (otoconia) become dislodged and migrate into the fluid-filled semicircular canals of the inner ear.
Another frequent cause is Vestibular Neuritis, which involves inflammation of the vestibular nerve, often due to a viral infection. This typically results in sudden, severe, and constant vertigo that can last for days, accompanied by nausea and vomiting, but without hearing changes. A related condition, Labyrinthitis, is similar but affects both the vestibular nerve and the cochlea, causing vertigo alongside noticeable hearing loss or ringing in the ear (tinnitus).
Ménière’s Disease is a different peripheral cause, marked by recurrent episodes of severe vertigo, often lasting several hours. This condition is associated with a buildup of fluid (endolymph) within the inner ear, which distorts balance and hearing signals. Patients typically experience vertigo attacks concurrently with fluctuating low-frequency hearing loss, tinnitus, and a feeling of pressure or fullness in the affected ear. These inner ear conditions account for the vast majority of vertigo presentations.
When Vertigo Is Linked to Cancer
The rare occurrence of vertigo associated with cancer stems from issues within the central nervous system, specifically the brainstem or cerebellum, which are the brain’s balance centers. This is referred to as central vertigo, caused by a tumor or lesion directly interfering with the brain’s processing of balance information. Unlike peripheral vertigo, the spinning sensation in central vertigo is often less intense but more persistent and constant.
One example is a Vestibular Schwannoma, a slow-growing, typically non-cancerous tumor that develops on the vestibular nerve sheath near the brainstem. Although benign, a large schwannoma can compress the nerve and adjacent brain structures, causing vertigo, hearing loss, and tinnitus. True malignant tumors, such as gliomas or medulloblastomas, can also cause central vertigo by growing in the cerebellum or brainstem, regions that coordinate movement and balance.
The presence of specific neurological symptoms, or “red flags,” primarily distinguishes central vertigo from its benign peripheral counterparts. These symptoms indicate a problem beyond the inner ear and include the sudden onset of severe, persistent vertigo unrelated to head position. Other concerning signs are a new, severe headache, double vision (diplopia), slurred speech, or profound difficulty walking (ataxia). The presence of these simultaneous symptoms suggests a structural issue requiring urgent investigation.
Navigating Diagnosis and Medical Next Steps
A medical evaluation for vertigo begins with a detailed patient history, focusing on the character, duration, and triggers of the spinning sensation, which helps classify it as peripheral or central. The physical and neurological examination includes checking for nystagmus, the involuntary, rhythmic movement of the eyes. The Dix-Hallpike maneuver, a specific test where the patient is rapidly moved into a supine position, is often performed to identify BPPV.
Specialized tests are frequently used to pinpoint the cause and rule out serious conditions. Audiometry (a hearing test) is important because the hearing and balance systems share the same inner ear space, meaning a problem in one often affects the other. Videonystagmography (VNG) or Electronystagmography (ENG) tests use goggles to record eye movements during visual tracking and when the inner ear is stimulated with warm or cool air or water. These tests provide objective data on vestibular function.
If a central cause is suspected based on the neurological examination or VNG results, imaging is the next step to visualize the brain and nerve structures. Magnetic Resonance Imaging (MRI) is the preferred tool for evaluating the posterior fossa, which contains the brainstem and cerebellum, due to its superior ability to visualize soft tissue. MRI can detect tumors, multiple sclerosis lesions, or signs of a stroke. This allows doctors to systematically differentiate between a benign inner ear problem and a potentially life-threatening condition in the central nervous system.