CCL4L2 is a potential biomarker for differentiating central and peripheral vertigo

Vertigo is encountered frequently in emergency services. Researchers have explored the role of serologic markers in the differentiation of central and peripheral vertigo. The study reported here was designed to evaluate the diagnostic efficacy of serologic markers (fibrinogen, D-dimer, and C-reactive protein [CRP]) in the differential diagnosis of peripheral and central vertigo. A total of 116 patients who sought treatment for vertigo at Gazi University Hospital Adult Emergency Services during a 3-mo period were included in the study. CRP, fibrinogen, and D-dimer levels were assessed in an effort to differentiate between cases of peripheral and central vertigo. In all, 65.5% of patients (76 patients) were women. Patients younger than 50 y of age accounted for 60.3% (70 patients). The average D-dimer level for the entire group of patients was 181.9+/-132.2 microg/mL, the average CRP level, 4.2+/-8.4 mg/L, and the average fibrinogen level, 421.9+/-176.0 mg/dL. Although serum D-dimer, fibrinogen, and CRP values appeared to be higher in patients with central vertigo than in those with peripheral vertigo, no statistically significant differences were noted between the 2 groups in terms of these 3 parameters (P>.05). When 6 mg/L was used as the cutoff point for CRP and 320 mg/dL was used for fibrinogen, the numbers of patients with CRP and fibrinogen levels higher than these values were significantly higher for central vertigo than for peripheral vertigo (P<.05). The present study shows that blood D-dimer, fibrinogen, and CRP levels cannot be significant markers for the differentiation of central and peripheral vertigo.

ObjectivesTo investigate the clinical value of using Head-Shaking Test (HST)+Head-Shaking Tilt Suppression Test (HSTST) to distinguish between peripheral and central vertigo as well as to analyze the consistency of findings between tests at the bedside vs. in the examination room. MethodsWe retrospectively analyzed patients who presented for central or peripheral vertigo from July 2019 to July 2021. The results were compared between HST and HST+HSTST. The concordance between bedside and examination room outcomes was analyzed. ResultsForty-seven (58.8%) patients in the peripheral vertigo group and 33 (41.2%) patients in the central vertigo group were included. In the peripheral group, 44 (both examination room and bedside: 93.6%) patients had horizontal Head-Shaking Nystagmus (hHSN), most of which were suppressed in HSTST. However, in the central group, most cases had perverted HSN (pHSN; examination room: 72.7%; bedside: 66.7%), which was seldomly suppressed in HSTST. The HST+HSTST showed a >20% higher specificity in identifying peripheral vertigo than HST alone. The bedside results were consistent with the examination room results using the kappa test (p<0.001). ConclusionsSuppressed hHSN was a strong indicator of peripheral vertigo. Conversely, pHSN was more often seen in central vertigo, which was not readily suppressed in HSTST. The bedside results of HST+HSTST yielded qualitative agreement with the tests in the examination room. HST+HSTST could be used as reliable methods in the clinic to distinguish between peripheral and central vestibular disorders. Level of evidenceLevel 3.

Background: Vertigo is a symptom of ischemic stroke. In vertigos without neurological symptoms, central vertigo cannot be definitively differentiated from peripheral vertigo. We can use the albumin to creatinine ratio (ACR) of urine in patients with central and peripheral vertigo to differentiate between central and peripheral vertigos which were the aim of this study. Methods: In this descriptive study, 60 patients (30 patients with central and 30 patients with peripheral vertigos) entered study and followed for one year. Necessary documents including age, sex, and medical records were obtained by face to face interview and patient's morning urine samples were sent to the laboratory for analysis of albumin to creatinine ratio. Collected data analyzed by statistical methods in SPSS-19. Results: 65% of patients were female and 35% male. The mean age of patients with central vertigo was 57.2±10.9 and peripheral vertigo was 53±12.5 years. The mean of albumin to creatinine ratio was significantly higher in patients with central vertigo compared to patients with peripheral vertigo (126/53 versus 38/7 mg/g; P=0.001). This difference was significant between men (P = 0.049) and women (P=0.03) of both groups. Also, it was significant in patients with >60 years old compare to others (P=0.002). Conclusions: Results showed that the mean level of albumin to creatinine ratio in patients with central vertigo was significantly higher than patients with peripheral vertigo, it seems that we can use urine albumin to creatinine ratio, as a low-cost test, to differentiate central vertigo from peripheral.

Aim: To evaluate the role of the diameter of the optic nerve sheath (ONSD) in the differential diagnosis of the central and peripheral vertigo in patients, who had applied with the complaints of vertigo. Method: Our study had a prospective design and 113 vertigo patients were included in the study. The demographic characteristics, vital signs, symptoms accompanying vertigo and findings of the imaging examinations were evaluated. Results: The median age of our patients was 43 years (IQR: 17) and 44.2 % of them were males. 19.5 % of the patients were diagnosed with central and 80.5 % with peripheral vertigo. In our study, the median ONSD was 4.88 mm (IQR=0.86) in patients with central vertigo and 4.65 mm (IQR=0.20) in patients with peripheral vertigo. The median value of ONSD in patients with central vertigo was significantly higher (p=0.030). In our study, the area under the curve was 0.654 (95 % CI=0.498-0.810) and the sensitivity and specificity for the cut-off value of 4.65 mm were 68.2 % and 61.5 % respectively. Conclusion: We determined that ONSD was larger in patients with central vertigo. Further studies with larger subject size are needed on this topic.

The study titled "Diagnostic Value of Neutrophil/Lymphocyte Ratio in Distinguishing Peripheral and Central Vertigo in Patients with Dizziness" explores the utility of the neutrophil-to-lymphocyte ratio (NLR) as a diagnostic marker for differentiating central and peripheral vertigo. Findings reveal that NLR is significantly higher in central vertigo cases (median: 3.99 vs. 2.32; p

Objective To explore the role of visual oculomotor-vestibular eye balance function in the diagnosis of central and peripheral vertigo. Methods From January 2015 to June 2016, one hundred and sixty-two patients with central vertigo who were treated at Kailuan General Hospital were enrolled in the study, including 124 males and 38 females, aged (64.09±10.98) years old; there were 166 cases of peripheral vertigo, 75 males and 91 females, aged (52.13±12.20) years old.Spontaneous nystagmus test, gaze test, position test, saccade test, smooth visual tracking test, visual single-speed test, visual sinus test, swivel chair rotation-emergency stop test using infrared video nystagmus and static balance posture instrument, open-closed eye hard plate erect test, open-closed eye sponge soft bottom erect test balance function electrophysiological test were conducted. Results The detection rate of pathological spontaneous nystagmus and pathological gaze nystagmus was higher in the central vertigo group than that in the peripheral vertigo group (χ2=5.674, 16.458, P<0.05). The occurrence rate of positional nystagmus was higher in peripheral vertigo group than that in central vertigo group (χ2=48.896, P<0.001). The abnormal rate of scanning test, stable visual tracking test, visual movement single speed and sinusoidal test, and static balance posture test were higher in the central vertigo group than those in the peripheral vertigo group (χ2=137.169, 166.972, 150.877, 150.877, 27.273, P<0.001), while the abnormal rate of rotating chair sudden stop test was higher in the central vertigo group than that in the peripheral vertigo group (χ2=51.000, P<0.001). The abnormal results were mainly scanned underflush and slow scan in central vertigo group (χ2=103.846, 4.296, P<0.05), stable visual tracking curve (χ2=147.389, 4.296, P<0.05) in type III-IV, and the gain of nystagmus decreased unilaterally and bilaterally (χ2=47.531, 44.477, 52.529, 53.255, P<0.001). Anomalies of proprioception in reverse and vertical nystagmus and static balance posture were induced by rotating chair sudden stop test (χ2=11.847, 23.778, P<0.001), while peripheral vertigo group showed unilateral decrease of nystagmus gain induced by rotating chair sudden stop test.(χ2=79.771, P<0.001). Conclusion The patients with peripheral vertigo have obvious body position spontaneous vestibular response and vestibular oculomotor system dysfunction, while the patients with central vertigo mainly have visual and oculomotor system dysfunction, and may be accompanied by vestibular oculomotor system and vestibular spinal reflex dysfunction. Key words: Vertigo; Videonystagmography; Static equilibrium posture

Background: In patients presenting with acute vertigo or dizziness, distinguishing central from peripheral is a diagnostic challenge. This study investigated potential serum markers for differentiating central and peripheral vertigo in patients with acute-onset vertigo.Methods: This prospective case–control study recruited consecutive participants from the Emergency Department, including patients with acute-onset vertigo or dizziness within 12 h and control subjects. We used enzyme-linked immunosorbent assays to measure the serum S100β, NSE, BDNF, GFAP, and IL-6 levels during the acute period.Results: The 114 study subjects included 28 patients with central vertigo (CV), 49 patients with peripheral vertigo (PV), and 37 age- and sex-matched healthy controls. No differences were found in risk factor distribution among the three groups. In patients with CV, the serum NSE and S100β levels were significantly (p < 0.05) elevated compared with the control and PV groups. The ROC analysis gave an AUC of 0.843 (95% CI = 0.753–0.932) for NSE and 0.787 (95% CI = 0.687–0.886) for S100β for predicting CV. However, there were no significant differences in the serum GFAP and BDNF levels among the CV, PV, and control groups.Conclusions: Serum NSE and S100β levels are significantly higher in patients with CV, such as occurs with posterior circulation ischemic stroke or vertebrobasilar insufficiency. S100β and NSE may serve as serum biomarkers for differentiating between CV and PV in patients with acute-onset vertigo.

Predictors of vertigo in the emergency department: The preved study

Comelian® was administered orally after meals to a total of 116 patients in a dosage of 2 tablets t. i. d. (300mg/day) for 8 weeks: 35 patients with central vertigo and 81 with peripheral vertigo.1) Peripheral vertigo: subjective improvement, moderate or better, was reported by 84.0%, and objective findings of improvement, moderate or better, were noted in 72.5%.The global improvement rate, moderate or better, was estimated to be 82.7%.2) A stratified analysis showed a better result in younger than in older patients and in those with a relatively short duration of illness. Also, there was no difference in efficacy between those treated with one course of this drug and those treated for a long time.3) Central vertigo: subjective improvement, moderate or better was reported by 68.6% and objective findings of moderate improvement or better were noted 43.8%.The global improvement rate, moderate or better, was 60.0%.4) A stratified analysis showed that efficacy tended to be slightly lower in those aged 70 years or over, as in the patients with peripheral vertigo, but the efficacy tended to be greater with long-term treatment.5) Adverse reactions occurred in 5 patients (4.3%). Treatment was stopped in 3, continued in 2. All 5 had peripheral vertigo.6) The global utility rate was 84.0% (satisfactory or better) in those with peripheral vertigo, and 60.0% in those with central vertigo.It is concluded that Comelian® is generally useful treatment of both central and peripheral vertigo in the outpatient.

Objective To evaluate the diagnostic value of sympathetic skin response(SSR)in patients with vestibular vertigo.Methods SSR tests were performed on 1 20 patients with acute vestibular system vertigo,including 70 cases of central vertigo and 50 eases of peripherM vertigo.60 healthy subjects were also examined to serve as controls.Results In those with central vertigo,the abnormality rate in the SSR results was 87.1%(61/70).SSR latency was longer and its amplitude wag lower than in those with peripheral vertigo and in the heMthy controls.In those with peripheral vertigo the abnormality rate was 18.0%(9/50),but the average latency and amplitude were not significantly different from those of the healthy controls.Conclusion Persons with acute central vestibular vertigo may have sympathetic nerve dysfunction.SSR test results can be used as an electrophysiological index to distinguish central from peripheral vestibular vertigo. Key words: Vestibular system; Vertigo; Sympathetic skin response; Functional assessment

This study was aimed to determine risk factors for central vertigo (CV) in patients with isolated vertigo accompanied by hearing loss or not. Patients with CV or peripheral vertigo (PV) who were admitted to our hospital between January 2014 and July 2016 were retrospectively reviewed. All patients underwent thorough physical examination with detailed medical histories recorded, including smoking, hypertension, diabetes, cardiovascular disease, and stroke history. Logistic regression estimated odds ratio (OR) of the risk factors. Eighty-seven patients were enrolled into the study, including 41 cases of CV and 46 cases of PV. There was significant difference in sex, age above 60, hypertension, diabetes, smoking, and stroke history between the 2 groups. The patients without any risk factors did not have CV. The risk for CV in the patients with ≥3 risk factors was greater (OR, 11.43; 95% confidence interval, 3.27-39.93; P<0.001) than the patients with 1 risk factor. The risk for CV in the patients with 2 risk factors was similar (OR, 0.833; 95% confidence interval, 0.17-4.28; P=0.825) to the patients with 1 risk factor. The patients with isolated vertigo (accompanied by hearing loss or not) and 3 or more risk factors are at higher risk for CV. They should have a comprehensive neurological examination and be closely followed up.

Dizziness is a common complaint among patients seen by primary care physicians, neurologists, and otolaryngologists. The most common causes of dizziness are peripheral vestibular disorders, but central nervous system disorders must be excluded. This article provides an overview of the epidemiology of dizziness, differentiating between central and peripheral vertigo, and central causes of dizziness. Dizziness is among the most common complaints in medicine, affecting approximately 20% to 30% of persons in the general population. Dizziness is a general term for a sense of disequilibrium. Vertigo is a subtype of dizziness, defined as an illusion of movement caused by asymmetric involvement of the vestibular system. Central vestibular lesions affecting the pons, medulla, or cerebellum cause vertigo, nausea, vomiting, severe ataxia, multidirectional nystagmus that is not suppressed by optic fixation, and other neurologic signs. The other types of dizziness are dysequilibrium without vertigo, presyncope, and psychophysiologic dizziness, which is often associated with anxiety, depression, and panic disorder. Epidemiologic studies indicate that central causes are responsible for almost one-fourth of the dizziness experience by patients. The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo. The most common central causes of dizziness and vertigo are cerebrovascular disorders related to the vertebrobasilar circulation, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, some drugs, and psychiatric disorders.

To investigate the usefulness of copeptin and S100B levels in the differentiation of central and peripheral vertigo. Ninety patients were included in the study. Copeptin and S100B levels were measured using the enzyme-linked immunosorbent assay method. The time between symptom onset and presentation to the emergency department was longer in the patients diagnosed with central vertigo. S100B and copeptin levels were significantly higher in central vertigo patients. The confirmed cut-off value was 17 for the S100B level and 1.65 for the copeptin level. Quick and reliable differentiation between central and peripheral vertigo is important to reduce the length of hospital stay of patients in the emergency department, and for patient comfort. S100B and copeptin levels are potential biomarkers in the differential diagnosis of central vertigo and peripheral vertigo for patients whose aetiology of vertigo cannot be differentially diagnosed with history-taking and physical examination.

A commonly overlooked cause of vertigo: Cervical spondylosis

ABSTRACTCentral vertigo can clinically manifest in three ways: Acute onset of vertigo and dizziness, recurrent attacks and chronic central vertigo. In patients with acute onset of symptoms it is essential to differentiate between central and peripheral vertigo because this has major diagnostic and therapeutic implications. A differentiation can most often be achieved by a careful neuroophthalmological and neuro-otological bedside examination. One should look in particular for the following five signs of central lesions: skew deviation/vertical divergence (as a component of the ocular tilt reaction), gaze-evoked nystagmus contralateral to a spontaneous nystagmus, saccadic smooth pursuit, acute nystagmus in combination with a nonpathological head-impulse test and central fixation nystagmus. The most frequent forms of central vertigo with recurrent attacks are vestibular migraine and episodic ataxia type 2. Clinically relevant types of chronic or chronic progressive central vertigo are neurodegenerative disorders affecting the cerebellum which are often associated with cerebellar ocular motor dysfunction, in particular downbeat nystagmus. Treatments of choice for a prophylactic therapy of vestibular migraine are betablocker, topiramate or valproic acid. A new treatment option for episodic ataxia type 2 and downbeat nystagmus are aminopyridines (potassium channel blockers).How to cite this articleStrupp M, Brandt T. Central Vertigo. Otorhinolaryngol Clin Int J 2012;4(2):71-76.