Patients are often classified into vestibular syndromes based on their clinical presentation (e.g., onset, triggers, and chronicity) in order to guide the diagnostic evaluation (e.g., Dix-Hallpike testing vs HINTS examination). Sense of motion (e.g., swaying, spinning)Īny of the Dangerous D's ( Dysphagia, Dysarthria, Diplopia, Dysmetria) strongly suggest a central cause of vertigo.
Horizontal, torsional, or vertical (e.g., down-beat nystagmus).Presence of dysmetria, dysphagia, dysarthria, or diplopia.
Nystagmus, hearing loss, and/or tinnitus may be present.No dysmetria, dysphagia, dysarthria, or diplopia.Stroke and acute obstructive hydrocephalus caused by a posterior fossa tumor are medical emergencies and require immediate management. See also “ Causes of peripheral vertigo.”.Benign paroxysmal positional vertigo (from semicircular canal debris).Meniere disease (from endolymphatic hydrops).Vestibular neuritis and/or labyrinthitis.Caused by inner ear (e.g., vestibulocochlear nerve, semicircular canals) lesions or dysfunction.Demyelination (e.g., in multiple sclerosis).Migraine (e.g., vestibular migraine, migraine with brainstem aura).Posterior fossa tumors (e.g., vestibular schwannoma, meningiomas).Brainstem ischemia (e.g., basilar artery occlusion, vestibular nuclei stroke).Lateral medullary (Wallenberg) syndrome.Ischemia and/or hemorrhage of the vertebrobasilar circulation (i.e., ischemic stroke, hemorrhagic stroke, TIA).Caused by c entral vestibular system (e.g., cerebellum, brainstem, vestibular nuclei) lesions or dysfunction.See also “ Vestibular neuritis”, “ Labyrinthitis”, “ BPPV”, and “ Meniere disease.” Definition Treatment depends on the underlying cause. Further testing, including laboratory studies, is not routinely required. Urgent neuroimaging is indicated in patients with suspected central vertigo. In patients with episodic, triggered vertigo, the Dix-Hallpike maneuver can be used to confirm benign paroxysmal positional vertigo ( BPPV), while in patients with acute vertigo without a clear trigger, head impulse, nystagmus, test of skew (HINTS) examination can be used to assess for central causes (e.g., ischemic stroke). Depending on the clinical presentation, targeted examination maneuvers may also be indicated. Clinical features and neurological examination findings can help identify the underlying cause. Peripheral causes (e.g., benign paroxysmal positional vertigo, vestibular neuritis) are typically benign, while central causes (e.g., posterior stroke, tumors of the posterior fossa) can be life-threatening. It is often confused with similar terms related to dizziness (e.g., disequilibrium, lightheadedness). Vertigo is the false sensation of motion (e.g., spinning or swaying) caused by dysfunction of the inner ear ( peripheral vertigo) or the central vestibular system ( central vertigo).