CDHB
Usually associated with other symptoms such as headache, ataxia, diplopia, hemiparesis.
In some patients with migraine headaches vertigo can occur as a migraine aura accompanying some or all of their headaches.
A large proportion of patients with vertebrobasilar distribution infarcts have preceding dizziness and vertigo. Ischaemia of brainstem nuclei and cerebellum cause abnormal perceptions of tilt and lateropulsion (falling). Ischaemia of the vascular supply to the ear can cause brief vertigo. Vascular ischaemic vertigo is typically brief and lasts minutes.
Vertigo, ataxia. Patients usually unable to stand. Nystagmus may be bi-directional or vertical, and not suppressed by optic fixation. If the head impulse test (see above) is positive the patient has vestibular neuritis. If the head impulse test is negative, the patient may have a cerebellar infarct and an early MRI scan is required.
Frequent early presentation is disturbance of balance and gait. A demyelinating lesion at the 8th nerve root entry zone can cause an attack of vertigo, which is initially indistinguishable from vestibular neuritis.
Schwannoma of the superior vestibular nerve. Presents with tinnitus, hearing loss in one ear and subtle deterioration of balance, but occasionally with acute vertigo. Differential diagnosis is Meniere's disease and other central causes.
Topic Code: 3777