From the Guidelines
Central causes of dizziness primarily stem from disorders affecting the brain and brainstem, including strokes, multiple sclerosis, vestibular migraine, tumors, and neurodegenerative disorders like Parkinson's disease, as noted in the most recent study 1. The main central causes of dizziness include:
- Strokes or transient ischemic attacks in the cerebellum or brainstem
- Multiple sclerosis
- Vestibular migraine
- Tumors, especially those affecting the cerebellopontine angle or fourth ventricle
- Neurodegenerative disorders like Parkinson's disease Medications that affect the central nervous system, such as anticonvulsants, antipsychotics, and some antihypertensives, can also trigger central dizziness, as mentioned in 1. Unlike peripheral vertigo, central dizziness often presents with additional neurological symptoms like:
- Diplopia
- Dysarthria
- Dysphagia
- Limb weakness The dizziness typically doesn't improve with position changes and may be constant rather than episodic. Nystagmus, when present, is often vertical or multidirectional rather than the horizontal nystagmus seen in peripheral causes, as noted in 1. Central dizziness requires prompt medical evaluation, as it may indicate serious underlying conditions, and brain imaging, particularly MRI, is essential for diagnosis, as recommended in the most recent study 1. Treatment focuses on addressing the underlying cause rather than symptom management, though vestibular rehabilitation may help with adaptation to chronic symptoms. In patients with acute vestibular syndrome (AVS), the HINTS examination can help distinguish between central and peripheral causes, and imaging may be required to rule out stroke, as discussed in 1.
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.