3 Warning Signs Your Vertigo Is Not Normal — Neurologist Dr. Anand Karnam Explains

Vertigo — the sensation that the room is spinning around you, or that you are spinning — is one of the most common complaints in a neurology clinic. Most people assume any dizziness is harmless and will settle on its own. Very often, they are right. But sometimes vertigo is a signal of something that genuinely needs medical attention, and missing that signal can have serious consequences.

Dr. Anand Karnam, Neurologist at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad, explains the three signs that separate concerning vertigo from the common, benign kind.

The Common Type of Vertigo — BPPV

The vast majority of vertigo cases seen in a clinic are caused by Benign Paroxysmal Positional Vertigo (BPPV). This is a mechanical problem in the inner ear — tiny calcium crystals (otoliths) get dislodged from their normal position and move into the semicircular canals, causing intense but brief spinning sensations triggered by head movement.

BPPV has a very characteristic pattern:

• Spinning sensation when turning over in bed, or looking up/down
• Lasts less than 60 seconds
• Comes on with specific head positions
• No hearing loss, no ear fullness, no neurological symptoms

BPPV is treated in the clinic with the Epley manoeuvre — a series of head movements that reposition the crystals. Most patients are better after one or two sessions. No medication is needed in most cases.

Warning Sign #1 — Vertigo That Lasts Hours or Days Continuously

BPPV episodes last seconds to a minute at most. If you have vertigo that persists continuously for hours or days — not triggered by position changes, just present all the time — this is not typical BPPV. Conditions to consider:

• Vestibular neuritis: Inflammation of the vestibular nerve (usually viral). Sudden severe vertigo lasting 24–72 hours, then gradually improving. Typically benign but needs diagnosis to rule out central cause
• Labyrinthitis: Like vestibular neuritis but also involves the cochlea, causing hearing loss alongside vertigo
• Stroke: Particularly important to exclude — a posterior circulation stroke can present exactly like vestibular neuritis. This is the dangerous one

Warning Sign #2 — Vertigo With Neurological Symptoms

Any vertigo accompanied by these symptoms requires urgent evaluation — they suggest the brain itself is involved, not just the inner ear:

• Double vision
• Difficulty speaking or swallowing
• Numbness or weakness of the face, arm, or leg
• Severe headache coming on at the same time as vertigo
• Difficulty walking — not just feeling unsteady, but genuinely unable to stand or walk without falling
• Loss of consciousness or near-fainting with vertigo

These combinations suggest a posterior fossa stroke, multiple sclerosis, or a brainstem lesion — all of which need emergency MRI and urgent neurological care.

Warning Sign #3 — Vertigo With New Hearing Loss or Ear Fullness

The combination of vertigo + ear fullness + fluctuating hearing loss + a roaring or ringing in one ear (tinnitus) is the classic presentation of Ménière's disease — an inner ear condition caused by abnormal fluid pressure. While not immediately dangerous, Ménière's disease causes repeated attacks that can be severely disabling, and it requires specialist management to prevent progressive hearing loss.

New sudden hearing loss alongside vertigo can also indicate an inner ear event requiring prompt treatment — some cases respond to steroid treatment if caught early.

Why Vertigo Happens When You Turn Over in Bed

The most common question from patients with BPPV is: "Why does the room spin only when I turn over in bed at night?" The answer is the anatomy of the inner ear. Each inner ear has three semicircular canals — fluid-filled loops oriented in different planes. When you move your head, the fluid moves, and tiny hair cells detect that movement and send signals to the brain about head position.

In BPPV, calcium carbonate crystals that normally sit on a membrane (the utricle) fall into one of the semicircular canals. When you roll over in bed, these crystals tumble through the canal, moving the fluid abnormally and firing a false "spinning" signal to the brain. The brain does not match this signal with what the eyes are seeing — and that mismatch is felt as vertigo.

The good news: the Epley manoeuvre physically guides these crystals back out of the canal. In Dr. Anand Karnam's clinic, most patients experience immediate improvement after a single Epley manoeuvre session.

When to See Dr. Anand Karnam for Vertigo in Hyderabad

See a neurologist for your vertigo if:

• The vertigo is severe, lasted more than a day, or is not triggered purely by head position
• You have any neurological symptoms alongside the vertigo
• You have hearing loss or ear fullness with the vertigo
• You have had multiple separate episodes of vertigo
• A home Epley manoeuvre has not helped
• You are falling or cannot walk safely due to the vertigo

Sri Anand Child and Neuro Center, Plot No 46, First Floor, Ameenpur Road, Chanda Nagar, Hyderabad. Call +91 90633 66983.