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vertigo - peripheral vs central

peripheral vs central vs systemic cause

peripheral vertigo features

nystagmus characteristics

  • horizontal or horizontorotary (esp. Meniere's which can last for hours)
  • bilateral
  • suppressed by visual fixation
  • nystagmus induced by head position testing:
    • long latency 10-20sec
    • short-lasting
    • fatigable

other suggestive features

  • episode precipitated by turning head to side whilst lying in bed suggests BPV
  • conductive deafness
    • suggests wax against tympanic membrane or otitis media as the cause
  • sensorineural deafness
    • suggests Meniere's disease, acoustic neuroma, ototoxins, suppurative labyrinthitis, perilymphatic fistula post-head injury
  • absence of other cranial nerve pathology except impaired corneal reflex (acoustic neuroma)

central vertigo features

nystagmus characteristics

  • vertical or torsional nystagmus
  • if horizontal then direction of fast phase alternates with gaze direction
  • unilateral or bilateral
  • may be enhanced by visual fixation
  • nystagmus induced by head position testing:
    • short latency
    • sustained duration
    • non-fatigable

other suggestive features

  • wide based ataxic gait or truncal ataxia whilst sitting with arms on lap
  • positive head impulse test
  • positive skew test
  • other neurology
    • vertebrobasilar infarct may cause either:
      • brainstem infarct ⇒ dysarthria, ataxia, facial numbness, hemiparesis, headache, diplopia
      • inf. cerebellar infarct ⇒ inability to walk, dysmetria, deafness
    • Wallenberg syndrome or lateral medullary syndrome due to occlusion of PICA
      • ⇒ ataxia, Horner's syndrome, loss of pain/temp. to ipsil. face & contralat. body; paralysis palate, pharynx, larynx.
    • multiple sclerosis (MS) ⇒ onset < 50yrs age; rotary/vert. nystagmus; internuclear ophthalmoplegia.
  • other features:
    • subclavian steal - precipitate by exercising arm; check BP in each arm;
    • sudden onset severe headache
      • exclude cerebellar haemorrhage which is a surgical emergency
        • ataxia +/- gaze disturbance on looking to side of lesion; cannot walk
      • subarachnoid haemorrhage (SAH) - does not usually present with vertigo but may do.
      • vertebrobasilar migraine - usually PH migraine
    • meningism

systemic vertigo

  • hypoglycaemia
  • hypothyroidism ⇒ unsteadiness, truncal ataxia or generalised clumsiness
  • hypotension
n_vertigo.txt · Last modified: 2018/09/16 18:00 (external edit)