21/05/2025
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🌀 Approach to Vertigo
Vertigo = a sensation of spinning or movement. Differentiate central vs. peripheral causes early.
⸻
🔴 Central Etiology
Clues:
•Direction-changing nystagmus
•Severe imbalance
•Neurological symptoms
🧠 Causes:
➊ Vestibular Migraine
• Recurrent episodes (minutes–hours)
• Often with headache and photophobia
➋ Vertebrobasilar TIA/Stroke
• Single or recurrent episodes
• Older age, vascular risk factors
➌ Multiple Sclerosis
• Progressive symptoms
• Young adults (20–40 years)
• ± Optic neuritis or INO (internuclear ophthalmoplegia)
➍ Brain Tumor
• Gradual progression
• Headache, hydrocephalus, focal deficits
⸻
🟠 Peripheral Etiology
Clues:
•Unidirectional nystagmus
•± Tinnitus, hearing loss
•Symptoms worsen with head movement
👂 Causes:
➊ Benign Paroxysmal Positional Vertigo (BPPV)
• Recurrent, brief episodes (seconds)
• Triggered by position change
• Positive Dix-Hallpike test
• Treatment: Epley maneuver
➋ Ménière’s Disease
• Recurrent episodes (minutes–hours)
• Sensorineural hearing loss + tinnitus
• Treatment: Salt restriction, diuretics
➌ Vestibular Neuritis
• Acute, single episode lasting days
• Often post-viral
• Hearing spared
• Treatment: Steroids, supportive care
➍ Labyrinthitis
• Like vestibular neuritis with hearing loss
• Usually viral
➎ Medication Effects
• Consider aminoglycosides, loop diuretics
• Discontinue offending agent
➏ Vestibular Schwannoma
• Gradual, one-sided hearing loss
• Order MRI/CT
⸻
🧪 Helpful Clinical Signs
•Test of Skew: Vertical ocular misalignment → central
•INO (Internuclear Ophthalmoplegia): Suggests MS or brainstem lesion
•Dix-Hallpike: Confirms BPPV (reproduces vertigo + nystagmus)
