- Last edited on June 1, 2023
Approach to Dizziness and Vertigo
Primer
Dizziness and Vertigo are common neurologic symptoms reported by patients, but the terminology can often be misused or misinterpreted by patients (or even medical professionals!).
Vertigo
Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Ménière’s disease are the most common causes of vertigo. However, cerebrovascular disease, migraines, psychiatric disorders, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms can also cause vertigo.
Approach
Types
Peripheral Vertigo
| Acute labrythinthitis | Inflammation of the labyrinthine organs caused by viral or bacterial infection |
|---|---|
| Acute vestibular neuronitis | Inflammation of the vestibular nerve, usually caused by viral infection |
| Benign positional paroxysmal vertigo (BPPV) | Transient episodes of vertigo caused by stimulation of vestibular sense organs by canalith. Affects middle-age and older patients; affects twice as many women as men |
| Chloesteatoma | Cyst-like lesion filled with keratin debris, most often involving the middle ear and mastoid. |
| Herpes zoster oticus | Vesicular eruption affecting the ear; caused by reactivation of the varicella-zoster virus |
| Meniere's disease | Recurrent episodes of vertigo, hearing loss, tinnitus, or aural fullness caused by increased volume of endolymph in the semicircular canals |
| Otosclerosis | Abnormal growth of bone in the middle ear leading to immobilization of the bones of conduction and a conductive hearing loss; this process may also affect the cochlea, leading to tinnitus, vertigo, and sensorineural hearing loss |
| Perilymphatic fistula | Breach between middle and inner ear often caused by trauma or excessive straining |
Central Vertigo
| Cerebellopontine angle tumor | Vestibular schwannoma (i.e., acoustic neuroma) as well as infratentorial ependymoma, brainstem glioma, medulloblastoma, or neurofibromatosis |
|---|---|
| TIA or Stroke | Arterial occlusion causing cerebral ischemia or infarction, especially if affecting the vertebrobasilar system |
| Migraines | Episodic headaches, usually unilateral, with throbbing accompanied by other symptoms such as nausea, vomiting, photophobia, or phonophobia; may be preceded by aura |
| Multiple Sclerosis | Demyelinization of white matter in the central nervous system |
Other Causes
| Cervical | Vertigo triggered by somatosensory input from head and neck movements |
|---|---|
| Drug-induced | Adverse reaction to medications |
| Psychiatric | Mood, anxiety, somatization, personality, or alcohol abuse disorders |