Further Inpatient Care
See the list below:
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Most patients with proven or suspected central vertigo should be admitted to the hospital for further evaluation and treatment.
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Patients should be admitted under the care of a neurologist or neurosurgeon.
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Patients with evidence of acute brainstem or cerebellar disease should be admitted to a monitored bed, preferably in an intensive care unit.
Transfer
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Transfer may be necessary for patients seen in facilities lacking cranial imaging capability or neurosurgical coverage. Transferred patients require monitoring and the availability of definitive airway management during the transport period.
Deterrence/Prevention
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A correct diagnosis of TIA followed by appropriate aspirin or anticoagulant therapy may decrease the risk of a future CVA significantly.
Prognosis
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Prognosis for patients with central vertigo depends on the underlying disease and is highly variable.
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Neurosurgical advancements have improved the prognosis for many serious conditions. This magnifies the importance of identifying these patients in the emergency setting.
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The prognosis of infarction of the basilar or vertebral arteries is poor. In one series, 45% of patients presented in coma. Importantly, half of the patients in this series had prodromal symptoms, including vertigo, which cleared completely in the 6 months prior to the stroke. [16]
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The prognosis for patients with spontaneous cerebellar hemorrhage is poor. Neurologic deterioration in these patients is associated independently with a hematoma in the central vermian area of the cerebellum and with secondary hydrocephalus. [3]
Patient Education
See the list below:
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Most causes of central vertigo have serious ramifications. Inform the patient of the suspected diagnosis in understandable terms and explain the necessity of hospital admission.
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For patient education resources, see the Brain and Nervous System Center. Also, see the patient education article Vertigo.
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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.
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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.
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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.
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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.
