From the Guidelines
Central causes of dizziness primarily include stroke, vestibular migraine, multiple sclerosis, brain tumors, and neurodegenerative disorders like Parkinson's disease, which can be diagnosed through neuroimaging and neurological examination. The main central causes of dizziness are disorders affecting the brain and brainstem, such as stroke or transient ischemic attack (TIA), particularly in the cerebellum or brainstem; vestibular migraine, which causes episodic vertigo with or without headache; multiple sclerosis, where demyelination affects central vestibular pathways; brain tumors that compress vestibular centers; and neurodegenerative disorders like Parkinson's disease 1. Medications that affect the central nervous system, such as anticonvulsants, antidepressants, and sedatives, can also induce dizziness.
Some key points to consider in diagnosing central causes of dizziness include:
- The presence of additional neurological symptoms like diplopia, dysarthria, dysphagia, or motor/sensory deficits, which distinguish central dizziness from peripheral causes 1
- The persistence of symptoms longer than peripheral vertigo and lack of improvement with head position changes
- The importance of prompt medical evaluation, especially with sudden onset, as conditions like stroke require immediate intervention
- The use of neuroimaging, such as MRI, which is preferred over CT for posterior fossa visualization, and neurological examination focusing on eye movements, coordination, and cranial nerve function 1
It is also important to note that some central causes of dizziness, such as vertebrobasilar insufficiency, can present with isolated attacks of vertigo, which may precede a stroke by weeks or months 1. In such cases, the diagnosis can be made through a combination of clinical evaluation, imaging studies, and laboratory tests.
Overall, a thorough diagnostic evaluation, including neuroimaging and neurological examination, is essential to determine the underlying cause of central dizziness and to guide appropriate treatment.
From the Research
Central Causes of Dizziness
The central causes of dizziness are numerous and can be attributed to various factors. Some of the most common central causes of dizziness include:
- Cerebrovascular disorders related to the vertebrobasilar circulation 2
- Migraine 2
- Multiple sclerosis 2
- Tumors of the posterior fossa 2
- Neurodegenerative disorders 2
- Certain drugs 2
- Psychiatric disorders 2
- Central autonomic network damage in the brain, which can cause central orthostatic hypotension in some neurodegenerative diseases 3
- Autoimmune vestibulocerebellar syndromes 3
- Superficial siderosis, which can be diagnosed with imaging studies 3
Diagnosis and Treatment
Diagnosing the central causes of dizziness can be challenging, but a thorough patient history, neurologic examination, and imaging studies can help differentiate between peripheral and central causes of vertigo 2, 4, 5. Treatment options vary depending on the underlying cause of dizziness, and may include vestibular rehabilitation, canalith repositioning procedures, and pharmacologic intervention 4. In some cases, treatment may involve addressing the underlying condition, such as cerebrovascular disease or neurodegenerative disorders 2, 5.
Specific Conditions
Certain conditions, such as vertebrobasilar insufficiency, can cause dizziness and vertigo due to transitory ischemia of the vertebrobasilar circulation 6. The diagnosis of vertebrobasilar insufficiency can be made using magnetic resonance angiography, transcranial Doppler ultrasound, and vertebrobasilar deprivation testing 6.