CNS Causes of Vertigo 

  • Author: Marcelo B Antunes, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 2, 2012
 

Background

Dizziness is a vague and nonspecific symptom. It refers to an abnormal sensation in relation to space and position. Vertigo is a specific type of dizziness that is defined as a spinning or rotatory sensation. Patients with vertigo report that things are rotating around them or that they are rotating around things.

Vertigo could be either from a peripheral (labyrinth and vestibular nerve) or a central disorder (central nervous system). Central vertigo is usually a result of an abnormal processing of the vestibular sensory input by the central nervous system.

See the image below.

Electrode montage for electronystagmography (ENG) Electrode montage for electronystagmography (ENG) testing.
Next

Pathophysiology

The sensation of balance is the result of appropriate information detected by the vestibular, ocular, and proprioceptive sensory receptors that is then properly integrated within the cerebellum and brain stem. Proper gait, posture, and visual focus during head movement all depend on an intact sense of balance. Loss of sensory information, central integration, and output control mechanisms all result in a sense of imbalance.

Central causes of vertigo result from either a disruption of central integrators (ie, brain stem, cerebellum) or a sensory information mismatch (ie, from the cortex). Lesions that affect the vestibular nerve or root entry zone (ie, cerebellopontine angle [CPA] lesions) result in imbalance by affecting primary vestibular sensory information.

Previous
Next

Epidemiology

Race

No racial predilection exists for CNS causes of vertigo.

Sex

Men and women are affected differently by different causes of CNS vertigo. Vestibular migraine, for example, shows a predilection for women.

Age

CNS causes of vertigo typically affect older population groups because of the associated risk factors of vascular causes of vertigo, such as hypertension, atherosclerosis, and diabetes mellitus.[1]

Younger population groups are more commonly affected by migraine headaches and multiple sclerosis (MS).[2] Cerebellar tumors affect a bimodal population of children and adults. CPA tumors typically affect people in the fifth to eighth decades of life.

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Marcelo B Antunes, MD  Resident Physician, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System

Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Ruckenstein  MD, MSc, Professor, Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Health System

Michael J Ruckenstein is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

B Viswanatha, MBBS, MS, DLO  Professor of Otolaryngology (ENT), Chief of ENT III Unit, Sri Venkateshwara ENT Institute, Victoria Hospital, Bangalore Medical College and Research Institute; PG and UG Examiner, Manipal University, India and Annamalai University, India

B Viswanatha, MBBS, MS, DLO is a member of the following medical societies: Association of Otolaryngologists of India, Indian Medical Association, and Indian Society of Otology

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting; Foresight Consulting fee Consulting

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

  1. Teggi R, Meli A, Trimarchi M, Liraluce F, Bussi M. Does Ménière's Disease in the Elderly Present Some Peculiar Features?. J Aging Res. 2012;2012:421596. [Medline]. [Full Text].

  2. Gruber M, Cohen-Kerem R, Kaminer M, Shupak A. Vertigo in children and adolescents: characteristics and outcome. ScientificWorldJournal. 2012;2012:109624. [Medline]. [Full Text].

  3. Gazquez I, Lopez-Escamez JA. Genetics of recurrent vertigo and vestibular disorders. Curr Genomics. Sep 2011;12(6):443-50. [Medline]. [Full Text].

  4. Solomon D. Distinguishing and treating causes of central vertigo. Otolaryngol Clin North Am. Jun 2000;33(3):579-601. [Medline].

  5. Rubin AM, Zafar SS. The assessment and management of the dizzy patient. Otolaryngol Clin North Am. Apr 2002;35(2):255-73. [Medline].

  6. Baloh RW, Harker LA. Central vestibular system disorders. In: Cummings CW, ed. Otolaryngology-Head and Neck Surgery,. 2nd ed. St. Louis, MO: Mosby; 1993:3177-3198.

  7. Chang CYJ, Gadre AK. Central Vestibulopathy. In: Bailey BJ, ed. Head and Neck Surgery- Otolaryngology. 4th ed. Philadelphia, PA: Lippincont; 2006:2303-2316.

  8. Serra A, Leigh RJ. Diagnostic value of nystagmus: spontaneous and induced ocular oscillations. J Neurol Neurosurg Psychiatry. Dec 2002;73(6):615-8. [Medline].

  9. Buttner U, Helmchen C, Brandt T. Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol. Jan 1999;119(1):1-5. [Medline].

  10. Lipton RB, Stewart WF. Prevalence and impact of migraine. Neurol Clin. Feb 1997;15(1):1-13. [Medline].

  11. Waters WE, O'Connor PJ. Prevalence of migraine. J Neurol Neurosurg Psychiatry. Jun 1975;38(6):613-6. [Medline].

  12. Cha YH. Migraine-associated vertigo: diagnosis and treatment. Semin Neurol. Apr 2010;30(2):167-74. [Medline].

  13. Lempert T, Neuhauser H. Migrainous vertigo. Neurol Clin. Aug 2005;23(3):715-30, vi. [Medline].

  14. Koehler B. Benign paroxysmal vertigo of childhood: a migraine equivalent. Eur J Pediatr. Aug 1980;134(2):149-51. [Medline].

  15. Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology. Feb 27 2001;56(4):436-41. [Medline].

  16. Reploeg MD, Goebel JA. Migraine-associated dizziness: patient characteristics and management options. Otol Neurotol. May 2002;23(3):364-71. [Medline].

  17. Lempert T, Neuhauser H, Daroff RB. Vertigo as a symptom of migraine. Ann N Y Acad Sci. May 2009;1164:242-51. [Medline].

  18. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med. Jun 23 2005;352(25):2618-26. [Medline].

  19. Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol. Jun 1993;50(6):609-14. [Medline].

  20. Amarenco P, Rosengart A, DeWitt LD, Pessin MS, Caplan LR. Anterior inferior cerebellar artery territory infarcts. Mechanisms and clinical features. Arch Neurol. Feb 1993;50(2):154-61. [Medline].

  21. Keim RJ. William F. House Lecture. Neurotologic manifestations of microvascular hypoperfusion. Am J Otol. Jan 1995;16(1):34-8. [Medline].

  22. Chang CC, Chang WN, Huang CR, Liou CW, Lin TK, Lu CH. The relationship between isolated dizziness/vertigo and the risk factors of ischemic stroke: a case control study. Acta Neurol Taiwan. Jun 2011;20(2):101-6. [Medline].

  23. Paul KS, Lye RH, Strang FA, Dutton J. Arnold-Chiari malformation. Review of 71 cases. J Neurosurg. Feb 1983;58(2):183-7. [Medline].

  24. Longridge NS, Mallinson AI. Arnold-Chiari malformation and the otolaryngologist: place of magnetic resonance imaging and electronystagmography. Laryngoscope. Mar 1985;95(3):335-9. [Medline].

  25. Williams NP, Roland PS, Yellin W. Vestibular evaluation in patients with early multiple sclerosis. Am J Otol. Jan 1997;18(1):93-100. [Medline].

  26. Tirelli G, Rigo S, Bullo F, Meneguzzi C, Gregori D, Gatto A. Saccades and smooth pursuit eye movements in central vertigo. Acta Otorhinolaryngol Ital. Apr 2011;31(2):96-102. [Medline]. [Full Text].

  27. [Guideline] Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. May 27 2008;70(22):2067-74. [Medline].

  28. [Guideline] Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. Nov 2008;139(5 Suppl 4):S47-81. [Medline].

 
Previous
Next
 
Electrode montage for electronystagmography (ENG) testing.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.