Visual Vertigo

Visual vertigo was defined by Professor Bronstein in 1995 as being a ‘syndrome where symptoms are triggered or exacerbated in situations involving rich visual conflict or intense visual stimulation. The main reason why this occurs is a sensory conflict or mismatch between the visual, vestibular, and musculoskeletal systems. It is thought that there is a possible discrepancy between what the person expected and the external information received. This results in an overdependence on vision to maintain balance and symptoms persist.

There are several causes of visual vertigo/motion sensitivity symptoms:

• Benign paroxysmal positional vertigo (BPPV)
• Labyrinthitis
• Vestibular neuritis
• Meniere’s Disease
• Migraine related vertigo
• Head injury
• Post-concussive and cervicogenic dizziness/whiplash-associated dizziness, just to name a few.

Rehabilitation of this complex condition requires a clear diagnosis and a comprehensive explanation to the patient so they can start the process of recovery. This places the patient at the center of the rehabilitation process and encourages them to challenge their symptoms in a graded manner. Fear and stress are common symptoms with many causes of loss of balance and can further exacerbate the symptoms. This is normal.

It is essential to note that visual vertigo can also be associated with other ocular conditions, such as glaucoma, which can impact the visual system and contribute to sensory mismatch. To learn more about glaucoma and its potential link to visual vertigo, check out our informative blog post on understanding glaucoma and its effects on vision and balance.

Further information about Visual Vertigo:

Visual Vertigo – Vestibular Rehabilitation                       

What is visual vertigo? Visual vertigo was defined by Professor Bronstein in 1995 as being a ‘syndrome where symptoms are triggered or exacerbated in situations involving rich visual conflict or intense visual stimulation.

What causes visual vertigo? The symptoms may develop a few days or weeks following an acute peripheral vestibular (inner ear, balance organ) disorder. Which would be experienced as spinning dizziness also known as rotatory vertigo. Visual problems may also cause visual vertigo or reduced sensory information from the body’s skin, ligaments muscles, tendons, or joints. Patients with a vestibular disorder and who develop a visual dependence are more likely to develop visual vertigo.

There are two main reasons why visual vertigo and motion sensitivity occur;

Motion sensitivity and visual vertigo are due to a sensory conflict or mismatch between the visual, vestibular, and somatosensory systems. It is thought that there is a possible discrepancy between what the person expected and the external information received.

Or

The combination of a vestibular disorder and subsequent visual dependence is what causes visual vertigo.

Both result in visual/motion sensitivity, and both result from being over-reliant on visual information and a mismatch of information in the balance system.

There are several causes of visual vertigo/motion sensitivity symptoms: Benign paroxysmal positional vertigo (BPPV), labyrinthitis, vestibular neuritis, Meniere’s Disease, migraine-related vertigo, head injury, post-concussive, and cervicogenic dizziness/ whiplash-associated dizziness, just to name a few.

If I have visual vertigo what am I likely to experience? symptoms of visual vertigo include tiredness, nausea, imbalance, vertigo, and disorientation. Visual vertigo can also lead to the exacerbation of psychological disorders, stress, anxiety, hyperventilation, and panic attacks. Symptoms can be provoked by moving traffic, traveling in a car, boat, plane, lift, or escalator, or motion of the visual surroundings. Examples of movement in your surroundings or moving visual objects include; – scrolling on a PC or tablet, running water, crowds, traffic, clouds, trees, leaves, or trees blowing in the wind, or watching TV or a motion picture. Patterns, such as stripy shirts or wallpaper, railings, or the light flickering through the trees.

How is visual vertigo diagnosed? The most important diagnostic tool is the patient history and the symptoms explained to the specialist. To confirm a diagnosis, questionnaires are often used which assess space and motion discomfort, particularly experienced in vestibular patients.

The Situational Characteristics Questionnaire (SCQ), Dizziness Handicap Inventory (DHI), and the Motion Sensitivity Quotient (MSQ) is the most frequently used tools in the diagnosis of motion sensitivity. An examination of your eye movements and other vestibular function tests can be performed to rule out central or peripheral vestibular pathology. The Clinical Test for Sensory Interaction and Balance (CTSIB) is a very important assessment tool to assess the sensory information which is received from the balance organs, visual system, and information from your body that keeps your balance.

Why has my dizziness not improved? Often when a person has dizziness or a balance problem they naturally start to avoid certain movements that make them feel worse. Avoidance behavior leads to maladaptive behavior which is used to further prevent vertigo symptoms.

Why do something that makes you feel dizzy or ill?

Recovery cannot occur if movements are avoided. The brain cannot learn or compensate for the changed information from your eye, balance organs, or the body. If the brain does

not sense dizziness then it does not realize something is wrong and cannot begin

compensation (i.e it cannot learn to adjust to the new information).

How is visual vertigo treated? Treatment for visual vertigo involves customized vestibular rehabilitation as well as educating the patient about compensation strategies. The three strategies used are Adaptation, Compensation, and Habituation.

Adaptation

The balance organs in both ears normally work together. If one side stops working effectively there becomes an imbalance of information often causing rotatory vertigo. e.g. after a vertigo attack, the patient might veer off to one side when walking. The brain needs to adapt to new information and adjust the balance system to these changes. Customized exercises are used to provide the brain with the information it needs to make these changes.

 Compensation

There is a memory bank in your brain that stores information from your eyes, body, and balance organs. Suppose there has been an upset within the balance system, the memory bank losses information. Balance retraining exercises help to restore this information with new information which strengthens the balance system, thus reducing your vertigo and improving your balance.

 Habituation

Continually repeating the actions that bring on the symptoms of dizziness or vertigo will eventually accustom the body to those actions and strengthen neural pathways.

Exercises are selected by identifying the motions and positions that provoke symptoms. Over time, with repeated motions, the vertigo symptoms reduce, and therefore further exercises can be introduced. Studies have shown that patients suffering from motion sensitivity benefit from optokinetic stimulation (OKS). We can provide you with a DVD containing video clips of moving black and white stripes and a rotating disk for use on your P/C, laptop, or DVD player. We also have virtual reality equipment which is used to reduce visual-vestibular conflict. As compensation occurs, the patient moves from a visual-dependent postural control to a more proprioceptive postural control with the use of vestibule-proprioceptive cues.