Vertigo

Vertigo = sensation of self or room spinning (hallucination of motion)
-vs presyncope (lightheaded, faint)
-vs instability
-vs other (malaise, viral illness, anemia, depression)

Affected pathway:
3 sensory mechanisms (visual, proprioception, vestibular) –> vestibular nuclei in brainstem –> cerebellum

History: time and rate of onset, duration of symptoms
-change in mental status is red flag

Exam:
-nystagmus: downbeating, torsional, or nonfatiguable = central
-skew deviation (cover one eye):

CENTRAL CAUSES

Cerebellar Stroke
-red flags: sudden onset, occipital headache, severe gait ataxia…difficulty speaking
-risk factors: age, cardiovascular disease (HTN, CAD, smoking)

Cerebral Artery Dissection 
-carotid artery – anterior neck pain
-vertebral artery – posterior neck pain

Vertebrobasilar Insufficiency
–one cause is subclavian steal syndrome
-check pulses and systolic BP in both arms

Acoustic Neuroma
-gradually progressive unilateral hearing loss and tinnitis
-vertigo rare!

 

PERIPHERAL CAUSES

BPPV
-normal at rest, onset with head movement

Vestibular Neuronitis
–episodic, severe, lasting hours, symptom-free episodes

Meniere’s Disease
-vertigo, hearing loss, tinnitis

Labyrinthitis

Vestibulitis