Smouha E. Inner ear disorders. NeuroRehabilitation. 2013. 32(3):455-62. [QxMD MEDLINE Link].
Schneider JI, Olshaker JS. Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke. Emerg Med Clin North Am. 2012 Aug. 30(3):681-93. [QxMD MEDLINE Link].
St. Louis EK, Wijdicks EF, Li H. Predicting neurologic deterioration in patients with cerebellar hematomas. Neurology. 1998 Nov. 51(5):1364-9. [QxMD MEDLINE Link].
Chen CC, Cheng PW, Tseng HM, Young YH. Posterior cranial fossa tumors in young adults. Laryngoscope. 2006 Sep. 116(9):1678-81. [QxMD MEDLINE Link].
Selesnick SH, Jackler RK, Pitts LW. The changing clinical presentation of acoustic tumors in the MRI era. Laryngoscope. 1993 Apr. 103(4 Pt 1):431-6. [QxMD MEDLINE Link].
Fitzgerald DC. Head trauma: hearing loss and dizziness. J Trauma. 1996 Mar. 40(3):488-96. [QxMD MEDLINE Link].
Amarenco P. The spectrum of cerebellar infarctions. Neurology. 1991 Jul. 41(7):973-9. [QxMD MEDLINE Link].
Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006 Oct 10. 67(7):1178-83. [QxMD MEDLINE Link].
Huon LK, Wang TC, Fang TY, Chuang LJ, Wang PC. Vertigo and stroke: a national database survey. Otol Neurotol. 2012 Sep. 33(7):1131-5. [QxMD MEDLINE Link].
Kase CS, Norrving B, Levine SR. Cerebellar infarction - clinical and anatomic observations in 66 cases. Stroke. 1993. 24 (1):76-83. [QxMD MEDLINE Link].
Hornig CR, Rust DS, Busse O, Jauss M, Laun A. Space-occupying cerebellar infarction. Clinical course and prognosis. Stroke. 1994 Feb. 25(2):372-4. [QxMD MEDLINE Link].
Halker RB, Barrs DM, Wellik KE, Wingerchuk DM, Demaerschalk BM. Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic. Neurologist. 2008 May. 14(3):201-4. [QxMD MEDLINE Link].
Drachman DA. A 69-year-old man with chronic dizziness. JAMA. 1998 Dec 23-30. 280(24):2111-8. [QxMD MEDLINE Link].
Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology. 2008 Jun 10. 70(24 Pt 2):2378-85. [QxMD MEDLINE Link].
Norrving B, Magnusson M, Holtas S. Isolated acute vertigo in the elderly; vestibular or vascular disease?. Acta Neurol Scand. 1995 Jan. 91(1):43-8. [QxMD MEDLINE Link].
Ferbert A, Bruckmann H, Drummen R. Clinical features of proven basilar artery occlusion. Stroke. 1990 Aug. 21(8):1135-42. [QxMD MEDLINE Link].
Lee SH, Choi SK, Lim YJ, Chung HY, Yeo JH, Na SY, et al. Otologic manifestations of acoustic neuroma. Acta Otolaryngol. 2015 Feb. 135 (2):140-6. [QxMD MEDLINE Link].
Simmons Z, Biller J, Adams HP Jr, Dunn V, Jacoby CG. Cerebellar infarction: comparison of computed tomography and magnetic resonance imaging. Ann Neurol. 1986 Mar. 19(3):291-3. [QxMD MEDLINE Link].
Hacke W, Zeumer H, Ferbert A. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988. 19 (10):1216-22. [QxMD MEDLINE Link].
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14. 333(24):1581-7. [QxMD MEDLINE Link].
Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. Feb 2005. 352:777-85. [QxMD MEDLINE Link].
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. Jan 2007. 369:283-92. [QxMD MEDLINE Link].
Giles MF, Rothwell PM. Systematic review and pooled analysis of published and unpublished validations of the ABCD and ABCD2 transient ischemic attack risk scores. Stroke. 2010 Apr. 41 (4):667-73. [QxMD MEDLINE Link].
Kim AS, Fullerton HJ, Johnston SC. Risk of vascular events in emergency department patients discharged home with diagnosis of dizziness or vertigo. Ann Emerg Med. 2011 Jan. 57(1):34-41. [QxMD MEDLINE Link].
Anagnostou E, Varaki K, Anastasopoulos D. A minute demyelinating lesion causing acute positional vertigo. J Neurol Sci. 2008 Mar 15. 266(1-2):187-9. [QxMD MEDLINE Link].
Bradley WG. MR of the brain stem: a practical approach. Radiology. 1991 May. 179(2):319-32. [QxMD MEDLINE Link].
Bruzzone MG, Grisoli M, De Simone T, Regna-Gladin C. Neuroradiological features of vertigo. Neurol Sci. 2004 Mar. 25 Suppl 1:S20-3. [QxMD MEDLINE Link].
Delaney KA. Bedside diagnosis of vertigo: value of the history and neurological examination. Acad Emerg Med. 2003 Dec. 10(12):1388-95. [QxMD MEDLINE Link].
Froehling DA, Silverstein MD, Mohr DN. Does this dizzy patient have a serious form of vertigo?. JAMA. 1994 Feb 2. 271(5):385-8. [QxMD MEDLINE Link].
Gacek RR. A Perspective on Recurrent Vertigo. ORL J Otorhinolaryngol Relat Spec. 2013 Jun 21. 75(2):91-107. [QxMD MEDLINE Link].
Gizzi M, Riley E, Molinari S. The diagnostic value of imaging the patient with dizziness. A Bayesian approach. Arch Neurol. 1996 Dec. 53(12):1299-304. [QxMD MEDLINE Link].
Herr RD, Zun L, Mathews JJ. A directed approach to the dizzy patient. Ann Emerg Med. 1989 Jun. 18(6):664-72. [QxMD MEDLINE Link].
Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med. 1998 Sep 3. 339(10):680-5. [QxMD MEDLINE Link].
Macdonell RA, Kalnins RM, Donnan GA. Cerebellar infarction: natural history, prognosis, and pathology. Stroke. 1987. 18 (5):849-55. [QxMD MEDLINE Link].
Mayer SA, Brun NC, Begtrup K. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2005 Feb. 352(8):777-85. [QxMD MEDLINE Link].
Rother J, Wentz KU, Rautenberg W. Magnetic resonance angiography in vertebrobasilar ischemia. Stroke. 1993. 24 (9):1310-15. [QxMD MEDLINE Link].
Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol. 1993 Jun. 50(6):609-14. [QxMD MEDLINE Link].
Solomon D. Distinguishing and treating causes of central vertigo. Otolaryngol Clin North Am. 2000 Jun. 33(3):579-601. [QxMD MEDLINE Link].

Media Gallery

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.

of 4

Author

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

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: InCarda Therapeutics<br/>Received ownership interest from General Electric and Medtronic for none. for: Equity ownership: GE Healthcare; Medtronic; Gilead; Cytodyn; Amgen; Pfizer.

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 Program Director, Emergency Medicine, Einstein Medical Center Montgomery

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

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.

Sections Central Vertigo
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Central Vertigo Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?