From the Guidelines
Vertigo, or dizziness, can be caused by various factors, including benign paroxysmal positional vertigo (BPPV), central paroxysmal positional vertigo (CPPV), vestibular migraine, and other conditions such as stroke, multiple sclerosis, and cerebellar hemorrhage 1.
Common Causes of Vertigo
- Benign Paroxysmal Positional Vertigo (BPPV): caused by mobile debris (canaliths) in the vestibular labyrinth, often triggered by specific head movements 1.
- Central Paroxysmal Positional Vertigo (CPPV): may be caused by mass lesions, hemorrhage, infarct, and demyelinating disease, among others, and can clinically mimic BPPV 1.
- Vestibular Migraine: can mimic various causes of dizziness and vertigo, often associated with headache and other migrainous features such as photophobia, phonophobia, and visual aura 1.
- Stroke: including posterior circulation infarct involving the brainstem or cerebellum, which can cause acute vestibular syndrome (AVS) 1.
- Multiple Sclerosis: involving the brainstem or cerebellar peduncles, a rare cause of AVS 1.
- Cerebellar Hemorrhage: a rare cause of isolated AVS 1.
- Vestibular Neuritis and Labyrinthitis: benign peripheral causes of AVS, without associated findings on CT imaging 1.
- Chronic Vertebrobasilar Insufficiency (VBI): characterized by transient disruption of blood flow in the posterior circulation, which supplies the thalami, cerebellum, and brainstem, often associated with brainstem neurologic deficits 1.
Diagnosis and Imaging
Imaging evaluation may be necessary to rule out central causes of vertigo, such as stroke, especially in patients with abnormal neurologic examination or HINTS examination consistent with central vertigo 1. However, in patients with typical BPPV, imaging is often unnecessary 1. The HINTS examination, performed by specially trained practitioners, can be useful in distinguishing AVS of benign cause from posterior circulation infarct 1.
From the Research
Causes of Vertigo
The causes of vertigo can be categorized into central and peripheral causes.
- Central causes are related to the central nervous system and can be caused by cerebrovascular disorders, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, some drugs, and psychiatric disorders 2.
- Peripheral causes are related to the vestibular system and can be caused by benign paroxysmal positional vertigo, Meniere disease, vestibular neuritis, and labyrinthitis 3, 4, 5.
Common Causes of Vertigo
Some of the most common causes of vertigo include:
- Benign paroxysmal positional vertigo (BPPV) 3, 4, 5
- Meniere disease 3, 4, 5
- Vestibular neuritis 3, 4, 5
- Labyrinthitis 3, 5
- Cerebrovascular disorders related to the vertebrobasilar circulation 2, 6
- Migraine 2
- Multiple sclerosis 2
- Tumors of the posterior fossa 2
- Neurodegenerative disorders 2
- Psychiatric disorders 2, 3
Diagnosis of Vertigo
The diagnosis of vertigo can be challenging, but a stepwise approach can help differentiate between causes 4, 5.
- The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo 2.
- Physical examination tests, such as evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing, can help narrow the differential diagnosis 3.
- Laboratory testing and radiography play little role in diagnosis 3.