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Causes of Central Vertigo

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Abstract

Central vertigo is vertigo that arises due to an abnormality in the central nervous system (CNS). Traditionally, and on some anatomic and functional grounds, the vestibular system and by implication the causes of vertigo have been divided into the central and peripheral subcategories. Peripheral causes of vertigo involve the semicircular canal and saccule/ utricle. Central causes of vertigo are primarily located in the brainstem and the 8th nerve. This is not surprising given the centrality of connections from the peripheral system that relay in the brainstem including postural control, eye movements, spinal reflexes, and the adjacent cerebellum with which it connects intimately.

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References

  1. Arch AE, et al. Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke. 2016;47(3):668–73.

    Article  PubMed  Google Scholar 

  2. Lever NM, et al. Missed opportunities for recognition of ischemic stroke in the emergency department. J Emerg Nurs. 2013;39(5):434–9.

    Article  PubMed  Google Scholar 

  3. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med. 2005;352(25):2618–26.

    Article  CAS  PubMed  Google Scholar 

  4. Lee CC, et al. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study. Stroke. 2011;42(1):48–52.

    Article  PubMed  Google Scholar 

  5. 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;57(1):34–41.

    Article  PubMed  Google Scholar 

  6. Amarenco P, et al. Anterior inferior cerebellar artery territory infarcts. Mechanisms and clinical features. Arch Neurol. 1993;50(2):154–61.

    Article  CAS  PubMed  Google Scholar 

  7. Lee H, et al. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke. 2009;40(12):3745–51.

    Article  PubMed  Google Scholar 

  8. Grad A, Baloh RW. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol. 1989;46(3):281–4.

    Article  CAS  PubMed  Google Scholar 

  9. Kim JS, Lee H. Vertigo due to posterior circulation stroke. Semin Neurol. 2013;33(3):179–84.

    Article  PubMed  Google Scholar 

  10. Navi BB, et al. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. Stroke. 2012;43(6):1484–9.

    Article  PubMed  Google Scholar 

  11. Oas JG, Baloh RW. Vertigo and the anterior inferior cerebellar artery syndrome. Neurology. 1992;42(12):2274–9.

    Article  CAS  PubMed  Google Scholar 

  12. Lee H, Yi HA, Baloh RW. Sudden bilateral simultaneous deafness with vertigo as a sole manifestation of vertebrobasilar insufficiency. J Neurol Neurosurg Psychiatry. 2003;74(4):539–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kim JS. Vertigo and gait ataxia without usual signs of lateral medullary infarction: a clinical variant related to rostral-dorsolateral lesions. Cerebrovasc Dis. 2000;10(6):471–4.

    Article  CAS  PubMed  Google Scholar 

  14. Lee H, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67(7):1178–83.

    Article  CAS  PubMed  Google Scholar 

  15. Kattah JC, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–10.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tarnutzer AA, et al. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183(9):E571–92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim HA, Lee H. Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy. Stroke. 2010;41(7):1558–60.

    Article  PubMed  Google Scholar 

  18. Chang TP, Wu YC. A tiny infarct on the dorsolateral pons mimicking vestibular neuritis. Laryngoscope. 2010;120(11):2336–8.

    Article  PubMed  Google Scholar 

  19. Chen L, et al. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit. J Neurol. 2011;258(5):855–61.

    Article  CAS  PubMed  Google Scholar 

  20. Saber Tehrani AS, et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 2014;83(2):169–73.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Edlow JA, Newman-Toker D. Using the physical examination to diagnose patients with acute dizziness and vertigo. J Emerg Med. 2016;50(4):617–28.

    Article  PubMed  Google Scholar 

  22. Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol. 2014;5:30.

    PubMed  PubMed Central  Google Scholar 

  23. Teggi R, et al. Vestibular assessment in patients with vestibular schwannomas: what really matters? Acta Otorhinolaryngol Ital. 2014;34(2):123–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Barbara M, et al. Double localization of a unilateral sporadic vestibular schwannoma. Acta Otorhinolaryngol Ital. 2008;28(1):34–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Franco-Vidal V, Negrevergne M, Darrouzet V. Vertigo and pathology of the cerebello-pontine angle. Rev Laryngol Otol Rhinol (Bord). 2005;126(4):223–6.

    CAS  Google Scholar 

  26. Kentala E, Pyykko I. Clinical picture of vestibular schwannoma. Auris Nasus Larynx. 2001;28(1):15–22.

    Article  CAS  PubMed  Google Scholar 

  27. Wuertenberger CJ, Rosahl SK. Vertigo and tinnitus caused by vascular compression of the vestibulocochlear nerve, not intracanalicular vestibular schwannoma: review and case presentation. Skull Base. 2009;19(6):417–24.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ryu H, et al. Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptoms? Acta Neurochir. 1999;141(5):495–501.

    Article  CAS  PubMed  Google Scholar 

  29. Savundra PA, et al. Migraine-associated vertigo. Cephalalgia. 1997;17(4):505–10. discussion 487.

    Article  CAS  PubMed  Google Scholar 

  30. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8(Suppl 7):1–96.

    Google Scholar 

  31. Headache Classification Committee of the International Headache, S. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.

    Article  Google Scholar 

  32. O’Connell Ferster AP, Priesol AJ, Isildak H. The clinical manifestations of vestibular migraine: a review. Auris Nasus Larynx. 2017;44(3):249–52.

    Article  PubMed  Google Scholar 

  33. Bottini G, et al. Identification of the central vestibular projections in man: a positron emission tomography activation study. Exp Brain Res. 1994;99(1):164–9.

    Article  CAS  PubMed  Google Scholar 

  34. Zaffaroni M, Baldini SM, Ghezzi A. Cranial nerve, brainstem and cerebellar syndromes in the differential diagnosis of multiple sclerosis. Neurol Sci. 2001;22(Suppl 2):S74–8.

    Article  PubMed  Google Scholar 

  35. Commins DJ, Chen JM. Multiple sclerosis: a consideration in acute cranial nerve palsies. Am J Otol. 1997;18(5):590–5.

    CAS  PubMed  Google Scholar 

  36. Frohman EM, et al. Vertigo in MS: utility of positional and particle repositioning maneuvers. Neurology. 2000;55(10):1566–9.

    Article  CAS  PubMed  Google Scholar 

  37. Rae-Grant AD, et al. Sensory symptoms of multiple sclerosis: a hidden reservoir of morbidity. Mult Scler. 1999;5(3):179–83.

    Article  CAS  PubMed  Google Scholar 

  38. Pula JH, Newman-Toker DE, Kattah JC. Multiple sclerosis as a cause of the acute vestibular syndrome. J Neurol. 2013;260(6):1649–54.

    Article  CAS  PubMed  Google Scholar 

  39. Schumacher GA. Demyelinating diseases as a cause for vertigo. Arch Otolaryngol. 1967;85(5):537–8.

    Article  CAS  PubMed  Google Scholar 

  40. Patel K, et al. Cerebellar ataxia following prolonged use of metronidazole: case report and literature review. Int J Infect Dis. 2008;12(6):e111–4.

    Article  PubMed  Google Scholar 

  41. Woodruff BK, Wijdicks EF, Marshall WF. Reversible metronidazole-induced lesions of the cerebellar dentate nuclei. N Engl J Med. 2002;346(1):68–9.

    Article  PubMed  Google Scholar 

  42. Bottenberg MM, et al. Metronidazole-induced encephalopathy: a case report and review of the literature. J Clin Pharmacol. 2011;51(1):112–6.

    Article  PubMed  Google Scholar 

  43. Ralph ED. Clinical pharmacokinetics of metronidazole. Clin Pharmacokinet. 1983;8(1):43–62.

    Article  CAS  PubMed  Google Scholar 

  44. Agarwal A, et al. Metronidazole-induced cerebellar toxicity. Neurol Int. 2016;8(1):6365.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bradley WG, Karlsson IJ, Rassol CG. Metronidazole neuropathy. Br Med J. 1977;2(6087):610–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Jung I, et al. Delayed vestibulopathy after heat exposure. J Neurol. 2017;264(1):49–53.

    Article  PubMed  Google Scholar 

  47. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002;346(25):1978–88.

    Article  CAS  PubMed  Google Scholar 

  48. Bazille C, et al. Brain damage after heat stroke. J Neuropathol Exp Neurol. 2005;64(11):970–5.

    Article  PubMed  Google Scholar 

  49. Albukrek D, et al. Heat-stroke-induced cerebellar atrophy: clinical course, CT and MRI findings. Neuroradiology. 1997;39(3):195–7.

    Article  CAS  PubMed  Google Scholar 

  50. Choi KD, et al. The vestibulo-ocular reflexes during head impulse in Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry. 2007;78(10):1161–2.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Witt ED, Goldman-Rakic PS. Intermittent thiamine deficiency in the rhesus monkey. I. Progression of neurological signs and neuroanatomical lesions. Ann Neurol. 1983;13(4):376–95.

    Article  CAS  PubMed  Google Scholar 

  52. Furman JM, Becker JT. Vestibular responses in Wernicke’s encephalopathy. Ann Neurol. 1989;26(5):669–74.

    Article  CAS  PubMed  Google Scholar 

  53. Tarnutzer AA, et al. Clinical and electrographic findings in epileptic vertigo and dizziness: a systematic review. Neurology. 2015;84(15):1595–604.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Alpers BJ. Vertiginous epilepsy. Laryngoscope. 1960;70:631–7.

    Article  CAS  PubMed  Google Scholar 

  55. Nagayama M, et al. Novel clinical features of nonconvulsive status epilepticus. F1000Res. 2017;6:1690.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Penfield W, Kristiansen K. Seizure onset and the localization of epileptic discharge. Trans Am Neurol Assoc. 1948;73(73 Annual Meet):73–80.

    CAS  PubMed  Google Scholar 

  57. Kim DW, Sunwoo JS, Lee SK. Incidence and localizing value of vertigo and dizziness in patients with epilepsy: video-EEG monitoring study. Epilepsy Res. 2016;126:102–5.

    Article  PubMed  Google Scholar 

  58. Guldin WO, Grusser OJ. Is there a vestibular cortex? Trends Neurosci. 1998;21(6):254–9.

    Article  CAS  PubMed  Google Scholar 

  59. Hewett R, et al. Benign temporo-parieto-occipital junction epilepsy with vestibular disturbance: an underrecognized form of epilepsy? Epilepsy Behav. 2011;21(4):412–6.

    Article  PubMed  Google Scholar 

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Correspondence to Dhasakumar Navaratnam .

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Lawal, O., Navaratnam, D. (2019). Causes of Central Vertigo. In: Babu, S., Schutt, C., Bojrab, D. (eds) Diagnosis and Treatment of Vestibular Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-97858-1_25

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  • DOI: https://doi.org/10.1007/978-3-319-97858-1_25

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