Neurologic Origins of Dizziness & Vertigo

Neurologic Origins of Dizziness & Vertigo

1Clinical presentations of Dizziness or Vertigo that is of Neurologic OriginNeurologically mediated dizziness can be reported as:Presyncope

Disequilibrium

True Vertigo

Confusion or disorientation

2Characteristics of Neurologically Mediated DizzinessEpisodic Multiple sclerosisMigraine auraAuras of seizure disordersPosterior cerebral circulation transient ischemic attacks

Unremitting & progressively worsening dizzinessBrain tumor

3Characteristics of Neurologically Mediated DizzinessSudden onset in patient with risk of atherosclerosis Thromboembolism to the vertebal or basilar artery

Movement or position-provoked dizzinessPresyncope when rising from supine position orthostatic hypotensionPresyncope from lateral neck rotation carotid sinus hypersensitivity syndrome

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the Diagnostic WorkupNature and extent of diagnostic workup depend on the differential and provisional diagnosesHistory & physical examination

Imaging studies

VNG, rotational chair testing, and posturography

Cardiovascular evaluation

Electroencephalogram (EEG)

5Special Neurologic Conditions Associated with Dizziness or VertigoCerebrovascular disease

Multiple sclerosis

Paraneoplastic neurological syndromes

Migraine

Mal de Dbarquement

Spinocerebellar and episodic ataxias

Autonomic insufficiency

Postconcussive syndrome

Medication- and substance-induced dizziness

61. Cerebrovascular disease - STROKESudden onset of neurologic deficit that is caused by:Hemorrhage (hemorrhagic stroke)

Cessation of blood flow to a brain region (ischemic stroke)Related to cerebrovascular atherosclerosis, vertebrobasilar insufficiency (VBI)

Can cause permanent or transient damage to the brain

71. Cerebrovascular disease - STROKEEffects when the cerebellum, vestibular nuclei, & connections are damaged:Dizziness, vertigo, or unsteadiness

Diplopia, dysarthria, bilateral weakness, nausea, abrupt onset

Duration:Few minutes with transient ischemic attacksDays to months with permanent ischemia

82. Multiple SclerosisChronic illness characterized by recurrent episodes of demyelination of nerve fibers in the CNS

Symptoms:FatigueVisual deficitsNumbnessVertigo or unsteadinessDysarthriaFacial nerve pain

Treatment for episodic vertigo vestibular suppressant (meclizine or diazepam)

93. Paraneoplastic Neurologic SyndromesRemote effects of cancer on the CNS, Peripheral nervous system, Autonomic nervous system, and Muscles

Partially triggered by autoimmune processes

103. Paraneoplastic Neurologic SyndromesParaneoplastic cerebellar degenerationMost often caused by gynecologic malignancy, lung carcinoma, Hodgkins lymphoma

Patients may present with:

Probable VNG findings:

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