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| *Vertigo is derived from the [[Latin]] word vertō which means "a whirling or spinning movement"<ref>"Definition of vertigo". Merriam-Webster Online Dictionary.</ref>.
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| ==Classification==
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| {{familytree/start}}{{familytree | | | | | | | A01 | | | |A01= Classification of Vertigo<ref name="Dieterich2007">{{cite journal|last1=Dieterich|first1=Marianne|title=Central vestibular disorders|journal=Journal of Neurology|volume=254|issue=5|year=2007|pages=559–568|issn=0340-5354|doi=10.1007/s00415-006-0340-7}}</ref><ref name="Karatas2008">{{cite journal|last1=Karatas|first1=Mehmet|title=Central Vertigo and Dizziness|journal=The Neurologist|volume=14|issue=6|year=2008|pages=355–364|issn=1074-7931|doi=10.1097/NRL.0b013e31817533a3}}</ref><ref name="Guerraz2001">{{cite journal|last1=Guerraz|first1=M.|title=Visual vertigo: symptom assessment, spatial orientation and postural control|journal=Brain|volume=124|issue=8|year=2001|pages=1646–1656|issn=14602156|doi=10.1093/brain/124.8.1646}}</ref>}}
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| {{familytree | | | | | | | |!| | | | | | | | }}
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| {{familytree | | | | | | | B01 | | | |B01=Based on Location of Dysfunction}}
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| {{familytree | | |,|-|-|-|-|^|-|-|-|-|.| }}
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| {{familytree | | C01 | | | | | | | |C02|C01=Peripheral<br>Accounts for over 90% of all causes of vertigo|C02=Central}}
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| {{familytree | | |!| | | | | | | | | |!| }}
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| {{familytree | | D01 | | | | | | | |D02|D01=Lesion in inner ear or vestibulocochlear nerve|D02=Lesion in brainstem or cerebellum}}
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| {{familytree | | |!| | | | | | | | | |!| }}
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| {{familytree | | E01 | | | | | | | |E02|E01=Meniere’s disease<br>Benign positional paroxysmal vertigo''<br>Acute labyrinthitis''<br>Acute vestibular neuronitis''<br>Cholesteatoma''<br>Otosclerosis''<br>Perilymphatic fistula''<br>Acoustic Neuroma''|E02=Brainstem Stroke<br>Vestibular Migraine''<br>Multiple Sclerosis''<br>Cerebellar ischemia or hemorrhage''<br>Cerebellar tumors''<br>lateral medullary syndrome''<br>Chiari malformation''}}
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| {{Family tree/end}}
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| ==Pathophysiology==
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| ==Causes==
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| * '''Peripheral''' causes of vertigo includes<ref name="Karatas2008">{{cite journal|last1=Karatas|first1=Mehmet|title=Central Vertigo and Dizziness|journal=The Neurologist|volume=14|issue=6|year=2008|pages=355–364|issn=1074-7931|doi=10.1097/NRL.0b013e31817533a3}}</ref>:
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| {| class="wikitable" | | {| class="wikitable" |
| |'''Disease''' || '''Main Feature''' | | !align="center" style="background: #4479BA; color: #FFFFFF | '''Etiology''' |
| |-
| | ! align="center" style="background: #4479BA; color: #FFFFFF| '''Distinguishing Feature''' |
| | [[Ménière’s disease]] || Increased [[endolymph]] volume in [[semicircular canals]]. Recurrent vertigo, aural fullness, hearing loss and [[tinnitus]]
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| | [[Benign positional paroxysmal vertigo]] || Dislodged [[otoliths]] stimulate vestibular sense organ. Recurrent vertigo, nausea, vomiting, [[torsional]] [[nystagmus]]
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| | Acute [[labyrinthitis]] || Inflammation of [[labyrinth]]/ [[viral]] or [[bacterial]]. Temporary hearing loss, vertigo, off balance, [[tinnitus]]
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| | Acute [[vestibular]] [[neuritis]] || Inflammation of [[vestibular]] nerve caused by [[viral]] [[infection]]. Vertigo, hearing intact
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| | [[Cholesteatoma]] || Cyst/sac of [[keratin]] debris in middle ear. Fullness/pressure in the ear, vertigo, hearing loss, pain
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| | [[Otosclerosis]] || Abnormal bone growth in middle ear. Vertigo, [[tinnitus]] and, sensorineural hearing loss | | | [[M. genitalium]] || urethritis and urethral inflammation |
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| | [[Perilymphatic fistula]] || Abnormal connection between the middle ear and inner ear. Fullness/pressure in the ear, vertigo, hearing loss/sensitive hearing | | | [[T. vaginalis]] ||urethritis among heterosexual men |
| |}
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| * '''Central''' causes of vertigo includes<ref name="Kerber2009">{{cite journal|last1=Kerber|first1=Kevin A.|title=Vertigo and Dizziness in the Emergency Department|journal=Emergency Medicine Clinics of North America|volume=27|issue=1|year=2009|pages=39–50|issn=07338627|doi=10.1016/j.emc.2008.09.002}}</ref>:
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| {| class="wikitable"
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| |'''Disease''' || '''Main Feature'''
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| |- | | |- |
| | [[Brainstem Stroke]] || Vertigo, imbalance, double vision, slurred speech, and altered [[consciousness]]. | | | [[Physiologic Tremor]] || Postural tremor - High [[frequency]] 8–10 Hz, low [[amplitude]], irregular oscillations |
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| | [[Vestibular Migraine]] || Mostly unilateral severe throbbing [[headache]], vertigo lasting minutes to hours, sensitivity to motion/light/smell/noise, [[nausea]], [[vomiting]], imbalance. | | | Enhanced [[Physiologic]] Tremor ||Increased [[amplitude]] |
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| | [[Multiple Sclerosis]] || Vertigo may accompany other symptoms like vision problem, fatigue, [[numbness]]/[[tingling]], limited mobility, bladder/bowel/speech/swallowing impairment. | | | [[Cerebellar]] Tremor || [[Intention tremor]] - Low [[frequency]] <4 Hz |
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| | [[Cerebellar]] [[tumors]] || [[meningioma]] or [[schwannoma]] in [[cerebellopontine]] angle can cause vertigo due to pressure on [[vestibular]] [[nerve]]. | | | [[Drug]] Induced Tremor || Can enhance rest, action, postural tremors |
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| | [[Lateral medullary syndrome]] || Results from ischemia in the lateral part of the [[brainstem]]([[medulla oblongata]]). Associated with [[ataxia]], [[nystagmus]], vertigo, [[dysphagia]], [[dysarthria]]. | | | [[Orthostatic]] Tremor || [[Essential tremor]] variant, high [[frequency]] 14 Hz-18 Hz |
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| | [[Chiari malformation]] || Extension of brainstem into spinal canal. Associated with [[numbness]]/[[tingling]] of hands and feet, [[dysphagia]], vertigo, unsteady gait, hoarseness. | | |Holmes tremor || Combination of rest, action, and postural tremors, [[Frequency]] 2Hz-5Hz |
| |} | | |} |
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| ==Differentiating Vertigo from other Diseases==
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| *Vertigo is a type of dizziness therefore it must be differentiated from other diseases that causes imbalance, [[dizziness]], and [[lightheadedness]].<ref name="pmid16445269">{{cite journal| author=Labuguen RH| title=Initial evaluation of vertigo. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 2 | pages= 244-51 | pmid=16445269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16445269 }} </ref>
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| ==Epidemiology and Demographics==
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| *Among the patient who presents with [[dizziness]] in the primary care setting, fifty-four percent have vertigo upon investigation.<ref name="Kroenke1992">{{cite journal|last1=Kroenke|first1=Kurt|title=Causes of Persistent Dizziness|journal=Annals of Internal Medicine|volume=117|issue=11|year=1992|pages=898|issn=0003-4819|doi=10.7326/0003-4819-117-11-898}}</ref>
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| ==Screening==
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| *There is insufficient evidence to recommend routine [[screening]] for vertigo.
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| ==Risk Factors==
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| *There are no established risk factors for vertigo, as it is a symptom of an underlying disease.
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| *However, vertigo can be prevented in some cases by controlling the underlying cause:
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| **In [[vestibular]] [[migraine]] recognized triggers including altered sleep patterns, menstrual cycle, chocolate, red wine, ripened/aged cheese, should be avoided.
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| **Avoid drugs or toxins that may cause vertigo.
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| ==Natural History, Complications and Prognosis==
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| *Complications include:
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| **[[Anxiety]]
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| **[[Depression]]
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| **Difficulty performing daily tasks
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| **Diminished quality of life
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| **Impaired balance and coordination
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| *[[Prognosis]] of vertigo depends upon treating the underlying cause. However, vertigo due to a tumor has a poor prognosis compared to other causes of vertigo.
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| ==Diagnosis==
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| '''Diagnostic Study of Choice'''
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| *There are no established criteria for the diagnosis of vertigo. Associated signs and symptoms should be identified to reach the underlying cause of vertigo.
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| '''History and Symptoms'''
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| *It is important to differentiate between other causes of dizziness before evaluating for the cause of vertigo. True vertigo is described as the room spinning around the patient.
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| *Once true vertigo is established next step is to identify if the origin of dysfunction is central or peripheral.
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| *
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| '''Physical Examination'''
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| '''Laboratory Findings'''
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| *There are no diagnostic laboratory findings associated with vertigo.
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| *
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| '''Electrocardiogram'''
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| *There are no ECG findings associated with vertigo.
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| *ECG monitoring may be indicated if the cause of dizziness is uncertain.
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| '''X-ray'''
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| '''Echocardiography or Ultrasound'''
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| '''CT scan'''
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| '''MRI'''
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| *An MRI is indicated if the cause of vertigo is central in origin.
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| *An MRI can identify if the underlying cause is a brain tumor like a [[acoustic neuroma]](vestibular schwannoma) or other pathology in the cerebellopontine angle.
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| '''Other Imaging Findings'''
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| '''Other Diagnostic Studies'''
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| ==Treatment==
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| '''Medical Therapy'''
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| '''Surgery'''
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| '''Primary Prevention'''
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| '''Secondary Prevention'''
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| ==References==
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| {{Reflist|2}}
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