Dizziness classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2] Norina Usman, M.B.B.S[3]

Overview

Based on the symptoms, dizziness may be classified into vertigo, presyncope, disequilibrium, lightheadedness. Vertigo can further be classified into timing and trigger as well as based on the area of pathology such as central and/ or peripheral.

Classification

Dizziness may be classified into subtypes based on the symptoms:

Classification of Dizziness
Type of Dizziness	Description	Origin of Disorder
Type I Dizziness (Vertigo)	Rotational/spinning sensation Often instantaneous Oscillopsia may occur Often accompanied by nausea, vomiting, and a staggering gait	Vestibular system disorder (Peripheral OR Central)
Type II Dizziness (Impending faint/Presyncope)	Sensation of impending faint/loss of consciousness Pallor, dimness of vision, roaring in the ears, and diaphoresis may occur Recovery upon assuming the recumbent position is common	Non Vestibular system disorder
Type III Dizziness (Disequilibrium)	Loss of balance without an abnormal sensation in the head occurs Occurs when walking and disappears upon sitting down. Occurs as a result of a disorder of motor system control
Type IV Dizziness	Vague lightheadedness occurs It includes dizziness that cannot be identified with certainty as any of the other types

Classification

One way to classify dizziness and vertigo is based on the timing and trigger as follows:

-New episodic:
  - With triggers:
    -Triggered episodic vestibular syndrome (e.g., positional vertigo from BPPV)
  - Without triggers:
    -Spontaneous episodic vestibular syndrome (e.g., arrhythmia from cardiac causes)

-New continuous:
  - Post-exposure acute vestibular syndrome (e.g., after gentamicin)
  - Spontaneous acute vestibular syndrome (e.g., stroke of posterior fossa)

-Chronic, persistent:
  - Chronic vestibular syndrome (unilateral vestibular loss, present with head movement)
  - Spontaneous chronic vestibular syndrome (associated with degeneration of cerebellum)

Vertigo can be further classified into peripheral and central based on the area of pathology (explained further under the pathophysiology section):

-Central:
  -Ischemia or infarction of the brainstem
  -Vertebrobasilar insuffiency
  -Demyelination syndromes like multiple sclerosis
  -Space occupying lesions (both benign and malignant)
  -Arnold-Chiari malformation
  -Vestibular migraine

-Peripheral:
  -Benign Paroxysmal Positional Vertigo (BPPV)
  -Cogan syndrome (autoimmune condition that affects eyes and inner ears)
  -Acoustic neuroma
  -Herpes zoster
  -Labyrynthitis
  -Vestibular neuritis
  -Medication toxicity (e.g., aminoglycosides, etc)
  -Perilymphatic fistula