Vertigo

Resident Survival Guide Vertigo in Children

Vertigo Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Vertigo from other Diseases
Epidemiology and Demographics
Risk Factors
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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]

Synonyms and keywords:

Classification

Classification of Vertigo

Based on Location of Dysfunction

Peripheral Accounts for over 90% of all causes of vertigo

Central

Lesion in inner ear or vestibulocochlear nerve

Lesion in brainstem or cerebellum

Meniere’s disease Benign positional paroxysmal vertigo Acute labyrinthitis Acute vestibular neuronitis Cholesteatoma Otosclerosis Perilymphatic fistula Acoustic Neuroma

Brainstem Stroke Vestibular Migraine Multiple Sclerosis Cerebellar ischemia or hemorrhage Cerebellar tumors lateral medullary syndrome Chiari malformation

Causes

• Peripheral causes of vertigo includes:

Disease	Main Feature
Ménière’s disease	Increased endolymph volume in semicircular canals. Recurrent vertigo, aural fullness, hearing loss and tinnitus
Benign positional paroxysmal vertigo	Dislodged otoliths stimulate vestibular sense organ. Recurrent vertigo, nausea, vomiting, torsional nystagmus
Acute labyrinthitis	Inflammation of labyrinth/ viral or bacterial. Temporary hearing loss, vertigo, off balance, tinnitus
Acute vestibular neuritis	Inflammation of vestibular nerve caused by viral infection. Vertigo, hearing intact
Cholesteatoma	Cyst/sac of keratin debris in middle ear. Fullness/pressure in the ear, vertigo, hearing loss, pain
Otosclerosis	Abnormal bone growth in middle ear. Vertigo, tinnitus and, sensorineural hearing loss
Perilymphatic fistula	Abnormal connection between the middle ear and inner ear. Fullness/pressure in the ear, vertigo, hearing loss/sensitive hearing

• Central causes of vertigo includes:

Disease	Main Feature
Brainstem Stroke
Vestibular Migraine
Multiple Sclerosis
Cerebellar tumors
Lateral medullary syndrome
Chiari malformation

Differentiating Vertigo from other Diseases

• Vertigo must be differentiated from other diseases that cause imbalance, dizziness, and lightheadedness.

Epidemiology and Demographics

• Among the patient who presents with dizziness in the primary care setting, fifty-four percent have vertigo upon investigation.