VISUAL VERTIGO -- Outline
Timothy C. Hain, MD•Page last modified:
July 18, 2020
This page is an attempt to think about visual vertigo using a structured way. It may not be very useful for patients, and we suggest that instead they look at the overview page about visual vertigo.
As is the case for most physiological systems, there are three general classes of disturbance so we have 3 types of visual vertigo -- sensory, central, and motor. If you want to jump to the "chase", most people end up with with symptoms attributed to one of four entities: Visual dependence, ocular disturbance (i.e. sensory visual vertog below), migraine associated vertigo, or anxiety.
- In sensory visual vertigo, the eyes are still but there is an inappropriate signal, or lack of a signal coming from the eyes.
- Tilting of one eye -- these sorts of problems can be detected with tests such as the Lancaster red/green test or retinal photography and similar methodology
- with respect to the other eye
- 4th nerve palsy (which can cause torsional diplopia)
- Oculomotor nerve or nucleus lesions
- Ocular muscle weakness or restrictions
- With respect to other sensors of vertical
- Anisometropia (difference in the size of images on one eye vs. the other)
- Post-cataract surgery -- one eye can see world with one lens, other has different lens.
- "mono-vision" -- one eye for near, another for far. Size of world depends on eye being used.
- Astigmatism -- size of world may depend on position of eye with respect to glasses.
- Progressive lenses -- size of world may depend on position of eye with respect to glasses.
- Visual loss such as in retinitis pigmentosa or near blindness
- In central visual vertigo, the inappropriate signal is from the brain.
- Oversensitivity to visual stimuli, such as in migraine associated vertigo (mav) or visual dependence. This is the main one.
- Some patients have "visual snow", which is due to hypersensitivity of their visual cortex.
- Seizure as in epileptic vertigo
- inversion illusions (mainly migraine again).
- Abnormal motion processing, such as palinopsia
- Halpern's syndrome -- unsteadiness based on viewing with one eye. This is of questionable significance.
- Posterior cortical atrophy -- mysterious disorder related to Alzheimer's disease with shrinkage of back part of brain.
- Anxiety can also cause upweighting of visual motion signals and trigger visual vertigo.
- In motor visual vertigo, the eyes are moving, causing apparent movement of the world.
- Nystagmus syndromes such as
See this page for references about visual vertigo.