Vertigo causes

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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

Common causes of vertigo are Ménière’s disease, benign positional paroxysmal vertigo, labyrinthitis, vestibular neuritis. Life threatening causes to look for include brainstem ischemia/hemorrhage, hypertension crisis, drug overdose, cyanide poisoning.

Causes

Peripheral Vertigo Causes
Ménière’s disease	Increased endolymph volume in semicircular canals. Recurrent vertigo, aural fullness, hearing loss and tinnitus
Acoustic neuroma	tinnitus, ear pain, aural fullness, headache, facial weakness.
Benign paroxysmal positional 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
Herpes Zoster Oticus	Ear pain, facial palsy, hearing loss, tinnitus vertigo herpetic eruptions of the auricle and/or external auditory canal.
Cholesteatoma	Cyst/sac of keratin debris in middle ear. Fullness/pressure in the ear, vertigo, hearing loss, pain
Otosclerosis	Abnormal bone growth in the middle ear. Vertigo, tinnitus and, sensorineural hearing loss
Central Vertigo Causes
Brainstem Stroke	Vertigo, imbalance, double vision, slurred speech, and altered consciousness.
Vestibular Migraine	Mostly unilateral severe throbbing headache, vertigo lasting minutes to hours, sensitivity to motion/light/smell/noise, nausea, vomiting, imbalance.
Multiple Sclerosis	Vertigo may accompany other symptoms like vision problem, fatigue, numbness/tingling, limited mobility, bladder/bowel/speech/swallowing impairment.
Cerebellopontine angle tumors	meningioma or schwannoma in cerebellopontine angle can cause vertigo due to pressure on vestibular nerve.
Lateral medullary syndrome	Results from ischemia in the lateral part of the brainstem(medulla oblongata). Associated with ataxia, nystagmus, vertigo, dysphagia, dysarthria.
Chiari malformation	Extension of brainstem into spinal canal. Associated with numbness/tingling of hands and feet, dysphagia, vertigo, unsteady gait, hoarseness.
Other Causes
Medication induced	Aminoglycosides, anticonvulsants(phenytoin), anti-depressants(tricyclic antidepressants, monoamine oxidase), antihypertensives, diuretics (furosemide), barbiturates, cocaine, nitroglycerin, salicylates
Psychogenic	Mood, anxiety, or alcohol abuse disorders

• Life threatening causes of Vertigo:
  • Brainstem stroke
  • Cyanide poisoning
  • Drug overdose
  • Malignant hypertension
  • Cerebellar hemorrhage