From the Guidelines
Central causes of vertigo include conditions such as strokes in the brainstem or cerebellum, multiple sclerosis, vestibular migraine, and tumors affecting the central nervous system, which can be distinguished from peripheral causes by clinical features such as downbeating nystagmus and direction-changing nystagmus 1.
Key Characteristics of Central Vertigo
- Less intense but more persistent than peripheral vertigo
- Often accompanied by additional neurological symptoms like double vision, slurred speech, facial numbness, or limb weakness
- May not worsen with head movements
- Less responsive to vestibular suppressant medications like meclizine or dimenhydrinate
Diagnosis and Treatment
- Diagnosis usually requires brain imaging such as MRI to identify the underlying cause 1
- Treatment focuses on addressing the specific neurological condition rather than just managing symptoms
- For instance, stroke-related vertigo requires prompt medical attention with anticoagulants or thrombolytics, while vestibular migraine may respond to migraine preventive medications like topiramate or propranolol 1
Importance of Immediate Medical Evaluation
- Central vertigo generally indicates a more serious condition than peripheral vertigo and warrants immediate medical evaluation, especially when accompanied by other neurological deficits
- Failure to respond to conservative management should raise concern that the underlying diagnosis may not be BPPV and may indicate a central cause of vertigo 1
From the Research
Central Causes of Vertigo
The central causes of vertigo are numerous and can be attributed to various factors. Some of the most common central causes of vertigo include:
- Cerebrovascular disorders related to the vertebrobasilar circulation 2
- Migraine 2, 3
- Multiple sclerosis 2, 3, 4, 5, 6
- Tumors of the posterior fossa 2, 3
- Neurodegenerative disorders 2
- Certain drugs 2
- Psychiatric disorders 2
Epidemiology and Diagnosis
Epidemiologic studies indicate that central causes are responsible for almost one-fourth of the dizziness experienced by patients 2. The patient's history, neurologic examination, and imaging studies are usually the key to differentiating between peripheral and central causes of vertigo 2, 3.
Treatment and Management
Treatment options for central vertigo vary depending on the underlying cause. For example, multiple sclerosis can be treated with disease-modifying therapies (DMTs) such as interferons, glatiramer acetate, and teriflunomide 4, 5, 6. Guidelines are offered for when to image the brain or posterior circulation vasculature and when a patient with acute vertigo should be admitted for observation 3.
Associated Conditions
Central vertigo can be associated with other conditions such as: