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== | ==Overview== | ||
In order to reach the underlying cause of vertigo, it is important to first confirm the presence of true vertigo which is usually described as 'room spinning around'. Once that is established next step is to differentiate between the central and peripheral causes of vertigo. Time duration and associated signs and [[symptoms]] help in identifying the underlying cause. | |||
==History and Symptoms== | |||
===History=== | |||
Patients with vertigo may have a positive history of:<ref name="Baloh2016">{{cite journal|last1=Baloh|first1=Robert W.|title=Differentiating between peripheral and central causes of vertigo|journal=Otolaryngology–Head and Neck Surgery|volume=119|issue=1|year=2016|pages=55–59|issn=0194-5998|doi=10.1016/S0194-5998(98)70173-1}}</ref><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><ref name="Derebery1999">{{cite journal|last1=Derebery|first1=M. Jennifer|title=THE DIAGNOSIS AND TREATMENT OF DIZZINESS|journal=Medical Clinics of North America|volume=83|issue=1|year=1999|pages=163–177|issn=00257125|doi=10.1016/S0025-7125(05)70095-X}}</ref><ref name="Solomon2000">{{cite journal|last1=Solomon|first1=David|title=DISTINGUISHING AND TREATING CAUSES OF CENTRAL VERTIGO|journal=Otolaryngologic Clinics of North America|volume=33|issue=3|year=2000|pages=579–601|issn=00306665|doi=10.1016/S0030-6665(05)70228-0}}</ref><ref name="RosenbergGizzi2000">{{cite journal|last1=Rosenberg|first1=Michael L.|last2=Gizzi|first2=Martin|title=NEURO-OTOLOGIC HISTORY|journal=Otolaryngologic Clinics of North America|volume=33|issue=3|year=2000|pages=471–482|issn=00306665|doi=10.1016/S0030-6665(05)70221-8}}</ref> | |||
* History of room spinning around the patient | |||
* Different time course: | |||
**Lasting a Day or Longer: [[Vestibular neuronitis]], vertebrobasilar [[ischemia]] with [[labyrinth]] infarct, [[Brainstem stroke]], Inferior [[cerebellar]] [[infarct]]/bleed | |||
**Lasting Minutes to Hours: [[Meniere’s disease]], vertebrobasilar [[transient ischemic attack]] (TIA), [[Migraine]] [[headache]], [[Perilymph fistula]]. | |||
**Lasting Seconds: [[Benign paroxysmal positional vertigo]] | |||
{| class="wikitable" style="margin: 1em auto 1em auto" | |||
|+ | |||
!Distinguishing Feature||Peripheral Vertigo||Central Vertigo | |||
|- | |||
|[[Nausea]]||Could be severe||Variable | |||
|- | |||
|[[Vomiting]]||Could be severe||Variable | |||
|- | |||
|[[Hearing loss]]||Common||Rare | |||
|- | |||
|[[Tinnitus]]||Common||Rare | |||
|- | |||
|Other [[Neurological]] [[Symptoms]]||Rare||Common | |||
|} | |||
===Common Symptoms=== | |||
* Vertigo is a symptom itself. | |||
{{ | * Associated Signs and symptoms:<ref name="pmid11510399">{{cite journal| author=Hanley K, O'Dowd T, Considine N| title=A systematic review of vertigo in primary care. | journal=Br J Gen Pract | year= 2001 | volume= 51 | issue= 469 | pages= 666-71 | pmid=11510399 | doi= | pmc=1314080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11510399 }} </ref><ref name="Solomon2000" /><ref name="RosenbergGizzi2000" /> | ||
**[[Benign paroxysmal positional vertigo]]: Triggered by a change in head position. | |||
**Vertebrobasilar [[stroke]]: [[diplopia]], [[dysphagia]], [[dysarthria]], and [[numbness]] or weakness. | |||
**[[Acoustic neuroma]]: [[tinnitus]], ear pain, [[aural fullness]], [[headache]], facial weakness. | |||
**[[Vestibular Migraine]]: [[headache]], [[photophobia]], visual aura. | |||
**[[Ménière disease]]: hearing loss, [[tinnitus]] | |||
**Acute [[labyrinthitis]] or [[vestibular neuritis]]: recent viral infection | |||
**Medication induced: [[aminoglycosides]], [[anticonvulsants]] ([[phenytoin]]), [[anti-depressants]] ([[tricyclic antidepressants]], [[monoamine oxidase]]), [[antihypertensives]], [[diuretics]] ([[furosemide]]), [[barbiturates]], [[cocaine]], [[nitroglycerin]], [[salicylates]] | |||
== References == | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
Latest revision as of 00:19, 21 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
In order to reach the underlying cause of vertigo, it is important to first confirm the presence of true vertigo which is usually described as 'room spinning around'. Once that is established next step is to differentiate between the central and peripheral causes of vertigo. Time duration and associated signs and symptoms help in identifying the underlying cause.
History and Symptoms
History
Patients with vertigo may have a positive history of:[1][2][3][4][5]
- History of room spinning around the patient
- Different time course:
- Lasting a Day or Longer: Vestibular neuronitis, vertebrobasilar ischemia with labyrinth infarct, Brainstem stroke, Inferior cerebellar infarct/bleed
- Lasting Minutes to Hours: Meniere’s disease, vertebrobasilar transient ischemic attack (TIA), Migraine headache, Perilymph fistula.
- Lasting Seconds: Benign paroxysmal positional vertigo
| Distinguishing Feature | Peripheral Vertigo | Central Vertigo |
|---|---|---|
| Nausea | Could be severe | Variable |
| Vomiting | Could be severe | Variable |
| Hearing loss | Common | Rare |
| Tinnitus | Common | Rare |
| Other Neurological Symptoms | Rare | Common |
Common Symptoms
- Vertigo is a symptom itself.
- Associated Signs and symptoms:[6][4][5]
- Benign paroxysmal positional vertigo: Triggered by a change in head position.
- Vertebrobasilar stroke: diplopia, dysphagia, dysarthria, and numbness or weakness.
- Acoustic neuroma: tinnitus, ear pain, aural fullness, headache, facial weakness.
- Vestibular Migraine: headache, photophobia, visual aura.
- Ménière disease: hearing loss, tinnitus
- Acute labyrinthitis or vestibular neuritis: recent viral infection
- Medication induced: aminoglycosides, anticonvulsants (phenytoin), anti-depressants (tricyclic antidepressants, monoamine oxidase), antihypertensives, diuretics (furosemide), barbiturates, cocaine, nitroglycerin, salicylates
References
- ↑ Baloh, Robert W. (2016). "Differentiating between peripheral and central causes of vertigo". Otolaryngology–Head and Neck Surgery. 119 (1): 55–59. doi:10.1016/S0194-5998(98)70173-1. ISSN 0194-5998.
- ↑ Labuguen RH (2006). "Initial evaluation of vertigo". Am Fam Physician. 73 (2): 244–51. PMID 16445269.
- ↑ Derebery, M. Jennifer (1999). "THE DIAGNOSIS AND TREATMENT OF DIZZINESS". Medical Clinics of North America. 83 (1): 163–177. doi:10.1016/S0025-7125(05)70095-X. ISSN 0025-7125.
- ↑ 4.0 4.1 Solomon, David (2000). "DISTINGUISHING AND TREATING CAUSES OF CENTRAL VERTIGO". Otolaryngologic Clinics of North America. 33 (3): 579–601. doi:10.1016/S0030-6665(05)70228-0. ISSN 0030-6665.
- ↑ 5.0 5.1 Rosenberg, Michael L.; Gizzi, Martin (2000). "NEURO-OTOLOGIC HISTORY". Otolaryngologic Clinics of North America. 33 (3): 471–482. doi:10.1016/S0030-6665(05)70221-8. ISSN 0030-6665.
- ↑ Hanley K, O'Dowd T, Considine N (2001). "A systematic review of vertigo in primary care". Br J Gen Pract. 51 (469): 666–71. PMC 1314080. PMID 11510399.