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Central Vertigo Medication

  • Author: Keith A Marill, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
Updated: Apr 13, 2016

Medication Summary

Patients with depressed mental status may have documented or suspected increased intracranial pressure (ICP). Administer diuretics or corticosteroids to decrease pressure while planning more definitive actions. Administer this therapy preferably in consultation with a neurosurgeon.


H1- receptor antagonists

Class Summary

These agents may suppress vestibular responses through an effect in the CNS; however, the mechanism remains unknown. Some investigators believe this action is mediated primarily by central anticholinergic activity.

Dimenhydrinate (Dramamine, Dimetabs, Dymenate, Triptone)


A 1:1 salt of 8-chlorotheophylline and diphenhydramine, thought to be particularly useful in treatment of peripheral vertigo. Diminishes vestibular stimulation and depresses labyrinthine function through central anticholinergic activity.

Diphenhydramine (Benadryl, Bydramine, Hyrexin)


Used for treatment and prophylaxis of vestibular disorders.

Promethazine hydrochloride (Phenergan)


Used for symptomatic treatment of nausea in vestibular dysfunction.

An antidopaminergic agent effective in treatment of vertigo, blocks postsynaptic mesolimbic dopaminergic receptors in brain and reduces stimuli to brainstem reticular system.



Class Summary

Centrally, these agents inhibit vestibular responses, presumably by potentiating inhibitory GABA receptors.

Diazepam (Valium, Diastat, Diazemuls)


Probably most commonly used benzodiazepine to treat vertigo. Highly lipophilic and undergoes rapid redistribution after administration. Duration of effects in CNS relatively short, which may make it relatively less desirable.

Lorazepam (Ativan)


Sedative hypnotic in benzodiazepine class that has short time to onset and relatively long half-life.

Depresses all levels of CNS, including limbic and reticular formation, probably through increased action of GABA, a major inhibitory neurotransmitter.



Class Summary

Diuretic agents are used as a temporary measure to lower ICP until definitive intervention is performed.

Mannitol (Osmitrol)


Nonreabsorbable solute, decreases water reabsorption in water-soluble portions of nephron. Reduces reabsorption of sodium chloride as well. Perhaps more importantly, does not cross blood-brain barrier. Creates osmotic gradient, drawing water from brain into intravascular compartment. Used to lower ICP in variety of conditions.

Initially assess for adequate renal function in adults by administering test dose of 200 mg/kg IV over 3-5 min. Should produce a urine flow of at least 30-50 mL/h over 2-3 h.

In children, assess by administering same test dose and rate. Should produce a urine flow of at least 1 mL/kg/h over 1-3 h.

Furosemide (Lasix)


Loop diuretic that blocks transport of sodium, potassium, and chloride in thick ascending limb of loop of Henle in kidney. May enhance effect of mannitol and produce greater and more sustained decrease in ICP.



Class Summary

These agents are used to decrease brain edema associated with intracranial tumors.

Dexamethasone (Decadron)


Preferred corticosteroid for this purpose because it demonstrates high glucocorticoid potency and minimal mineralocorticoid activity.

Contributor Information and Disclosures

Keith A Marill, MD Faculty, Department of Emergency Medicine, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Received ownership interest from Medtronic for none; Received ownership interest from Cambridge Heart, Inc. for none; Received ownership interest from General Electric for none. for: GE; Medtronic; Cambridge Heart.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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CT scan of a patient with an acute spontaneous cerebellar hemorrhage. The hemorrhage in the right lobe of the cerebellum is partly obscured by bony artifact.
MRI of a patient with an acute cerebellar hemorrhage less than 24 hours after presentation. MRI allows better resolution than CT scan without bony artifact. MRI is preferred over CT scan for imaging lesions in the posterior fossa.
CT scan of a patient with a large acoustic neuroma on the right side of the brainstem. The scan was performed after injection of intravenous contrast, which is critical for identifying tumors with CT imaging.
A CT slice through the brain of a patient with an acoustic neuroma. This slice reveals a level of the brain higher than the acoustic neuroma. The dilated third and lateral ventricles provide gross evidence of obstructive hydrocephalus due to pressure exerted by the tumor on the brainstem. A ventriculostomy, seen as a white circle in the right lateral ventricle, has been placed in an attempt to drain cerebrospinal fluid and relieve the excessive pressure above the brainstem.
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