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Vertigo (view source)

Revision as of 09:47, 27 November 2023

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(Created page with "'''Vertigo''' is the sensation that you are moving, or everything moves around you. It's a common symptom in a variety of disorders, ranging from harmless to life-threatening. '''Acute vestibular syndrome''' is defined as the presence of severe vertigo lasting more than 24 hours which causes nausea and vomiting and an intolerance to head movement (because it makes the vertigo worse). == Etiology == The most common causes include: * Non-ENT causes ** Orthostatic hypot...")
 
 
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** Heart disease
** Heart disease
** Anaemia
** Anaemia
* Peripheral causes (defects of the vestibular system)
* Peripheral causes
** [[Vestibular neuritis]] (most common)
** [[Vestibular neuritis]] (most common)
** [[Benign positional paroxysmal vertigo]]  
** [[Benign positional paroxysmal vertigo]]  
* Central causes (defects of the CNS)
* Central causes
** Posterior circulation [[stroke]]
** Posterior circulation [[stroke]] or TIA
** Vestibular migraine


== Types ==
== Types ==
One can distinguish two types of vertigo:
One can distinguish two types of vertigo:


* Systematic (definite directional or rotational component)
* Peripheral vertigo
* Non-systematic (no motion components)
* Central vertigo
Peripheral vertigo is the most common and is caused by dysfunction of the vestibular system. Central vertigo is rare but can be fatal, and is due to disorder of the CNS. In Hungarian literature, these are called harmonic and disharmonic vestibular syndromes, respectively.


== Clinical features ==
== Clinical features ==
Nystagmus, nausea, and vomiting are all common features in people with vertigo. In case of focal neurological signs, posterior circulation stroke is likely. In case of tinnitus or hearing loss, peripheral causes are more likely.
Nystagmus, nausea, and vomiting are all common features in people with vertigo. In case of focal neurological signs, posterior circulation stroke is likely. In case of tinnitus or hearing loss, peripheral causes are more likely.
{| class="wikitable"
!
!'''Peripheral vertigo (harmonic vestibular syndrome)'''
!'''Central vertigo (disharmonic vestibular syndrome)'''
|-
!'''Nystagmus direction'''
|Never changes direction
Fast component away from affected ear. (Slow component toward affected ear)
|Direction may change based on gaze
Fast component toward affected side. (Slow component away from affected ear)
|-
!'''Nystagmus type'''
|Horizontal or combined horizontal and rotational
Never purely rotational or purely vertical
|Any direction
Purely vertical or purely rotational is always central
|-
!'''Sense of motion'''
|Severe, nausea and vomiting common
|Usually mild
|-
!'''Romberg test'''
|Patient falls toward the affected ear
|Patient falls toward the affected side
|-
!'''Does visual fixation suppress nystagmus?'''
|Yes
|No
|-
!'''Postural instability'''
|Instability toward affected side
Walking usually preserved
|Severe instability
Walking usually difficult
|-
!'''Other inner ear symptoms (hearing loss, tinnitus)'''
|May be present
|Usually not present
|-
!'''Ataxia, diplopia, dysphagia, weakness, other neurological symptoms'''
|Absent
|Often present
|}


== Diagnosis and evaluation ==
== Diagnosis and evaluation ==
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== Differential diagnosis ==
== Differential diagnosis ==
<noinclude>[[Category:Ear, nose, throat (ENT)]]</noinclude>
 
=== Peripheral vertigo ===
{| class="wikitable"
!'''Disorder'''
!'''Duration of episode'''
!'''Recurrence of vertigo'''
!'''Other symptoms'''
!'''Other clinical features'''
|-
|Vestibular neuritis
|Days
|Single episode
|Symptoms of viral infection earlier or during. Intolerance to head movement, spontaneous nystagmus, and a tendence to fall to the diseased side
|None
|-
|Benign paroxysmal positional vertigo
|Seconds
|Recurrent episodes
|Specific head movements and positions precipitate symptoms
|Positive Dix-Hallpike test
|-
|Ménière disease
|Hours
|Recurrent episodes
|Hearing loss, tinnitus
|Audiometry shows SN hearing loss
|-
|Otitis media
|Days
|Single episode
|Ear pain
|Characteristic findings on otoscopy
|}
 
=== Central vertigo ===
{| class="wikitable"
!'''Disorder'''
!'''Duration of episode'''
!'''Recurrence of vertigo'''
!'''Other symptoms'''
!'''Other clinical features'''
|-
|Vestibular migraine
|Minutes
|Recurrent episodes
|Headache, other symptoms of migraine
|None
|-
|TIA of vertebrobasilar system
|Minutes
|Single or multiple episodes
|Other brainstem or cerebellar symptoms
|MRI confirms ischaemia
|-
|Brainstem stroke
|Days
|Single episode
|Other brainstem symptoms
|MRI confirms infarct
|-
|Cerebellar stroke
|Days
|Single episode
|Other cerebellar symptoms
|MRI confirms infarct
|}
<noinclude>
[[Category:Ear, nose, throat (ENT)]]
</noinclude>