Central Vertigo Research Articles

A case report of labyrinthine infarction: a ‘central’ cause of vertigo with ‘peripheral’ presentation

Introduction and Importance: The inner ear is considered an ‘end organ’ since its vascular supply comes from one terminal artery, making the labyrinth especially vulnerable to ischemia, causing loss of auditory and vestibular function with variable clinical patterns according to the different arterial distribution in the inner ear and which vascular branches are concerned by the embolism. Case Presentation: We report a misleading case of central vascular vertigo caused by a labyrinthine infarction resulting from an embolic vertebral artery, which manifested in a typical peripheral clinical presentation mimicking a vestibular neuritis. Clinical Discussion: Vertigo is the result of asymmetrical responses from the vestibules of both ears resulting from any disruption along the complex vestibular pathways, whether peripheral or central. The recognition of the origin of an acute isolated vertigo is fundamental since the therapeutic strategy and prognosis differ, but it can be challenging in the absence of neurological signs, especially when the clinical pattern involves only the vestibular part of the labyrinth. Conclusion: The diagnosis strategy should consider the patient vascular risk factors and the clinical bedside tests with diffusion-weighted magnetic resonance imaging (MRI). Then, the management of these patients requires pluridisciplinary cooperation with early vestibular rehabilitation.

Vertigo as Initial Symptom of Cerebellar Hemorrhage in Adult Woman : A Case Report

Vertigo, difficulty walking, and loss of balance/coordination are among the symptoms of stroke in 50% of stroke cases. Vertigo due to cerebrovascular disease is generally associated with other neurological signs such as cranial nerve abnormalities, hemiparesis, facial weakness, diplopia, hyperesthesia, and Horner's syndrome. A 42-year-old woman came to the emergency department with complaints of dizziness, nausea, and frequent vomiting for the previous 4 hours. The symptoms are also accompanied by a feeling of tingling on the left side of the face, and the left eyelid cannot open optimally. The patient has a history of uncontrolled hypertension. The HINTS test revealed central vertigo, and the patient also found dysdiadochokinesis, ataxia, and dysmethria. A non-contrast head CT scan showed ICH in the left cerebellum with a volume of 6.9 cc. Based on the results of these examinations, the patient was diagnosed with cerebellar hemorrhage. The blood supply to the brainstem, cerebellum, and inner ear comes from the vertebrobasilar vascular system. Blockage or rupture of blood vessels in one of the main branches of this system can cause symptoms of vertigo. Symptoms of vertebrobasilar stroke vary widely and depend on which of the three main circumferential branches is affected; posterior inferior cerebellar artery, anterior inferior cerebellar artery, or superior cerebellar artery. Vertigo in patients who have risk factors for stroke accompanied by other neurological symptoms should be considered for a thorough neurological examination to evaluate the possibility of cerebrovascular disease.

A novel KCNC3 gene variant in the voltage-dependent Kv3.3 channel in an atypical form of SCA13 with dominant central vertigo.

Potassium channel mutations play an important role in neurological diseases, such as spinocerebellar ataxia (SCA). SCA is a heterogeneous autosomal-dominant neurodegenerative disorder with multiple sub-entities, such as SCA13, which is characterized by mutations in the voltage-gated potassium channel Kv3.3 (KCNC3). In this study, we present a rare and atypical case of SCA13 with a predominant episodic central rotational vertigo, while the patient suffered only from mild progressive cerebellar symptoms, such as dysarthria, ataxia of gait and stand, and recently a cognitive impairment. In this patient, we identified a heterozygous variant in KCNC3 (c.2023G > A, p.Glu675Lys) by next-generation sequencing. This Kv3.3E675K variant was studied using voltage-clamp recordings in Xenopus oocytes. While typical SCA13 variants are dominant-negative, show shifts in the voltage-dependence of activation or an altered TBK1 regulation, the Kv3.3E675K variant caused only a reduction in current amplitude and a more pronounced cumulative inactivation. Thus, the differences to phenotypes observed in patients with classical SCA13 mutations may be related to the mechanism of the observed Kv3.3 loss-of-function. Treatment of our patient with riluzole, a drug that is known to also activate potassium channels, turned out to be partly beneficial. Strikingly, we found that the Kv3.3 and Kv3.3E675K inactivation and the frequency-dependent cumulative inactivation was antagonized by increased extracellular potassium levels. Thus, and most importantly, carefully elevated plasma potassium levels in the physiological range, or novel drugs attenuating Kv3.3 inactivation might provide novel therapeutic approaches to rescue potassium currents of SCA13 variants per se. In addition, our findings broaden the phenotypic spectrum of Kv3.3 variants, expanding it to atypical phenotypes of Kv3.3-associated neurological disorders.

R-cVR, a two-step bedside algorithm for the differential diagnosis of acute dizziness and vertigo

BackgroundThe ability to quickly and accurately differentiate between peripheral and central dizziness or vertigo is vital. We developed the R-cVR algorithm for the early identification of central-type dizziness or vertigo. MethodsIn this single-center, retrospective cohort study, we assessed patients with isolated dizziness or vertigo between December 10, 2023, and February 28, 2024. Classification into central or peripheral types was based on magnetic resonance imaging (MRI)-diffusion-weighted imaging (DWI) results. We reevaluated the diagnostic value of the Romberg test for acute dizziness or vertigo by quantifying the duration of standing and created the R-cVR algorithm. The algorithm's accuracy was subsequently validated against the MRI-DWI results. ResultsAfter screening, 109 patients were recruited and divided into central (n = 25) and peripheral (n = 84) groups. The central group had a high incidence of cerebral infarction (88.0 %), whereas the peripheral group included patients with vestibular neuronitis, benign paroxysmal positional vertigo, and Meniere's disease (96.4 %). Significant disparities in the incidence of balance disorders were noted between the groups (92.0 % vs. 15.5 %, p < 0.001). Multivariate logistic regression revealed an odds ratio of 61.82 for balance disorders (p < 0.001). The R-cVR algorithm, which integrates the Romberg test and the V-shaped stance with closed-eyes protocol, was tested against MRI-DWI and yielded high diagnostic agreement (kappa = 0.80), with a sensitivity and specificity of 88.0 % and 94.0 %, respectively. There was no significant difference in the diagnostic efficacy of this algorithm for acute dizziness or vertigo with or without nystagmus. ConclusionThe R-cVR algorithm effectively identifies central-type dizziness or vertigo and is simple for general practitioners to use without specialized equipment, which may be valuable in various clinical settings.

Causal association between blood metabolites and vertigo: A Mendelian randomization study.

Metabolic disorders have been identified as an important factor causing nervous system diseases. However, due to the interference of confounding factors, the causal relationship between them has not been clearly elucidated, so it is necessary to study the causal relationship between them. To explore the causal relationship between blood metabolites and vertigo by Mendelian randomization. To assess causality, the inverse variance weighting method was employed as the primary analytical approach, complemented by additional sensitivity analyses. Metabolic pathway enrichment analysis and genetic correlation analysis were employed to further assess the metabolites. All statistical analyses were conducted using the R software. The study employed metabolite Genome Wide Association Study and vertigo diseases summary data sets to examine the causal relationship between 486 blood metabolites and 3 types of vertigo. A total of 55 potential metabolites associated with the 3 types of vertigo were identified, with 22, 16, and 13 candidate metabolites showing relatively reliable MR Evidence for Vestibular Dysfunction, Peripheral Vertigo, and Central Vertigo, respectively. Enrichment analysis was conducted to investigate the biological significance of these candidate metabolites, resulting in the identification of 7 key metabolic pathways across the 3 diseases, the metabolic pathway known as "Valine, leucine, and isoleucine biosynthesis" was found to be associated with all 3 types of vertigo, suggesting its potential influence on the vestibular system. Genetic correlation analysis revealed a genetic correlation between X-10510 and dodecanedioate with Vestibular Dysfunction. This study offers novel perspectives on the causal impact of blood metabolites on vertigo through the integration of genomics and metabolomics. Identifying metabolites that contribute to vertigo could serve as potential biomarkers and contribute to a better understanding of the underlying biological mechanisms associated with vertigo.

Diagnostic Value of Neutrophil/Lymphocyte Ratio in Distinguishing Peripheral and Central Vertigo in Patients with Dizziness

Objective: Neutrophil/lymphocyte ratio (NLR) is an inexpensive parameter that gives an idea about systemic inflammatory response and cellular immune response. This study aims to investigate the value of NLR in distinguishing peripheral and central vertigo. Materials and Methods: Patients presenting with acute vertigo at the emergency clinic were included between January 2017 and December 2018. Hemogram, brain computerized tomography, and diffusion magnetic resonance imaging data were reviewed to categorize patients into peripheral and central vertigo groups. Laboratory parameters were compared between these groups. Results: Neutrophil, lymphocyte, and C-reactive protein levels were higher in patients with central vertigo than those with peripheral vertigo (p=0.003, p=0.003, p=0.022, respectively). Moreover, the NLR value was significantly elevated in central vertigo cases (median: 3.99) in contrast to peripheral vertigo cases (median: 2.32) (p

The VeSFADS structural classification of vestibular disorders

The issuing of International Classification of Vestibular Disorders（ICVD） by Brny society（2015） greatly facilitates the progress of vestibular medicine. The syndromic classification of vestibular disorders by ICVD enable the physician to narrow the spectrum of differential diagnosis for the vestibular disorder in clinical practice. However, the division of vestibular pathway, especially the central vestibular system, has not be classified yet in the ICVD（2015）. Central vertigo, being a group of heterogeneous disorders, may present diverse clinical spectrums. The misdiagnosis of central vestibular as well as peripheral vestibular disorders have been reported in the clinic practice. Therefore, the author by review study proposes a structural classification of vestibular disorders combined the Vestibular System Functional Anatomy Division with Syndromes（VeSFADS）. The VeSFADS classification of vestibular disorders could help the physician in clinical practice to narrow the spectrum of vestibular disorders, in addition to the syndromic classification, by the clinical feature of vestibular disorders from different division of vestibular system. And the VeSFADS classification of vestibular disorders may facilitate to clarify the clinical features of vestibular disorders at different Division of vestibular pathway.

High-Frequency Vestibular Function Is Vulnerable to Presbyvestibulopathy.

In 2019, mild vestibular function deficiency in elder populations was defined as presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. The diagnostic criteria include tests for low-, mid-, and high-frequency vestibular function, represented by caloric testing, rotary chair testing, and head impulse testing, respectively. However, there is still a lack of large-scale reports supporting the relationship between vestibular function tests (VFTs) and aging. In this study, we evaluated whether each test is correlated with aging in the elderly population aged over 50. This study retrospectively enrolled 1043 subjects from a single university hospital database after excluding those with unilateral and bilateral vestibulopathy, central dizziness, and acute dizziness. Enrolled subjects had caloric canal paresis <20%, vHIT lateral canal gain >0.6, vHIT interaural difference <0.3, and age >50 years old. Significant negative correlations with age were identified in the vHIT (p < 0.001) and rotary chair test (RCT) 1.0 Hz gain (p = 0.030). However, the caloric test (p = 0.739 and 0.745 on the left and right sides, respectively) and RCT 0.12 Hz gain (p = 0.298) did not show a significant correlation with age. A total of 4.83% of subjects aged 70 years or older showed sub-normal vHIT gain that met the criteria of PVP, whereas only 0.50% of subjects aged 60 to 69 did. The prevalence of sub-normal caloric test results, however, was not significantly different between the two age groups (21.55% in the 60-69 age group and 26.59% in the >70 age group). The high-frequency range vestibular function seems vulnerable to aging, and this is more discernible at age >70 years. The weak correlation between age and low-frequency vestibular function tests, such as the caloric test and low-frequency rotary chair testing, suggests the need to revisit the diagnostic criteria for PVP.

The clinical significance of arterial stiffness in the differential diagnosis of vertigo

Objectives: Pulse wave velocity (PWV) is a known indicator of arterial stiffness reflecting vascular damage. However, there are few reports of the relationship between PWV and dizziness/vertigo of a vascular origin. We investigated whether the PWV value could be useful as an ancillary measurement for identifying the etiology of dizziness/vertigo.Methods: We enrolled dizzy patients from March 2016 to December 2018. The patients with posterior circulation stroke presenting with dizziness/vertigo were categorized as having central vertigo. The patients with vertigo due to benign paroxysmal positional vertigo, Ménière disease, or acute unilateral vestibulopathy were categorized as having peripheral vertigo. The PWV value, ankle-brachial index (ABI), and traditional vascular risk factors were collected.Results: We consecutively enrolled a total of 93 participants. The PWV values were higher in the central vertigo group (p&lt;0.001), but ABI did not differ between the groups. Among the vascular risk factors, the number of patients with diabetes mellitus, dyslipidemia, and male patients was significantly higher in the central vertigo group. The brachial-ankle PWV (baPWV) values were higher in the central vertigo group, even after adjusting for confounding factors (p&lt;0.01). The receiver operating characteristic curve showed that the sensitivity was 74% and specificity was 81% when the mean baPWV value was 14.78 m/sec.Conclusions: Increased baPWV values were observed in patients with dizziness/vertigo due to stroke. Measurement of the baPWV value could be an ancillary test for evaluating the cause of dizziness/vertigo, even though more convincing evidence is still required.

CENTRAL VERTIGO DUE TO ISCHEMIC STROKE IN A YOUNG WOMAN: A CASE REPORT

Background: Vertigo is a symptom that patients often complain about. Vertigo is divided into peripheral and central. One of the causes of central vertigo is ischemic stroke. Ischemic stroke generally occurs in elderly people, but in recent years there has been an increase cases in young people. In addition, the prevalence of stroke is more common in men than women, but recently there has been an increase cases in women. Case summary: A 25-year-old woman presented with sudden vertigo. Physical examination revealed obesity, bidirectional horizontal and vertical nystagmus, left hemiparesis, and hemihypesthesia. Head CT scan showed lacunar infarction in the right basal ganglia and periventricular. The patient was given antiplatelet and vertigo management. Conclusion: Vertigo should be differentiated between peripheral or central vertigo at the emergency department, as it will determine further management. Stroke can occur in young women. Therefore, it is important for clinicians to think about the diagnosis of stroke in patients with vertigo that occur in young women.

Blood biomarkers for the differentiation between central and peripheral vertigo in the emergency department: a systematic review and meta-analysis.

In patients with acute vestibular syndrome (AVS), differentiating between stroke and nonstroke causes is challenging in the emergency department (ED). Correct diagnosis of vertigo etiology is essential for early optimum treatment and disposition. The aim of this systematic review and meta-analysis was to summarize the published evidence on the potential of blood biomarkers in the diagnosis and differentiation of peripheral from central causes of AVS. A literature search was conducted for studies published until January 1, 2023, in PubMed, Ovid Medline, and EMBASE databases analyzing biomarkers for the differentiation between central and peripheral AVS. The Quality Assessment of Diagnostic Accuracy Studies questionnaire 2 was used for quality assessment. Pooled standardized mean difference and 95% confidence intervals were calculated if a biomarker was reported in two or more studies. Heterogeneity among included studies was investigated using the I2 metric. A total of 17 studies with 859 central and 4844 peripheral causes of acute dizziness or vertigo, and analysis of 61 biomarkers were included. The general laboratory markers creatinine, blood urea nitrogen, albumin, C-reactive protein, glucose, HbA1c, leukocyte counts, and neutrophil counts and the brain-derived biomarkers copeptin, S100 calcium-binding protein β (S100β), and neuron-specific enolase (NSE) significantly differentiated central from peripheral causes of AVS. This systematic review and meta-analysis highlights the potential of generalized inflammatory markers and brain-specific blood protein markers of NSE and S100β as diagnostic biomarkers for central from peripheral differentiation in AVS. These results, as a complement to clinical characteristics, provide guidance for future large-scale diagnostic research, in this challenging ED patient population.

Vestibular rehabilitation in complex therapy of vestibular vertigo (consensus of experts)

Experts discussed the problem of comprehensive medical treatment of vertigo through vestibular rehabilitation. Peripheral vestibular vertigo is most commonly caused by benign paroxysmal positional vertigo, Meniere's disease and vestibular neuronitis, while central vestibular vertigo is caused by vestibular migraine and stroke. Vestibular rehabilitation is one of the most effective areas of treatment for patients with various disorders of the vestibular system characterized by chronic dizziness. Vestibular rehabilitation improves patients' walking and stability and can lead to an improvement in patients' daily activities and quality of life. Currently, in our country medical rehabilitation centres are being established where patients with various causes of vestibular vertigo can receive complex therapy, including vestibular rehabilitation. The Expert Council recommends the comprehensive personalised use of vestibular rehabilitation in the complex treatment of various diseases manifested by dizziness. An educational program is needed for neurologists, ENT specialists and rehabilitation specialists in treatment of patients with different types of vestibular dizziness.

Statistical Associations between Vestibular Pathologies and Hypothyroidism: A Retrospective Study.

The association between vestibular pathologies and thyroid hormone disorders has been known for several decades. However, very little information is available on the types of vestibular symptoms that may be affected by altered thyroid hormone levels. The aim of this study was to provide patient data in order to identify statistical associations between vestibular pathologies and thyroid hormone disorders. A retrospective review of the records of 422 patients seen for physiotherapy treatment of vertigo was carried out. Statistical analysis of the data was performed using logistic regression, providing Chi2 and Odds Ratio statistics. Our results show that hypothyroidism statistically significantly increases the expression of certain symptoms, such as vestibular instability and gait disorders, in vestibular pathologies such as Menière's disease or central vertigo. By analyzing patient data, our study provides new evidence of dependence between altered thyroid status and the expression of vestibular pathologies.

Spontaneous vertebral artery stenosis, dissection and cerebellar infarction in a gentleman while playing bowling.

Background: An increased incidence of vertebral artery dissection has recently become a recognized cause of acute stroke for about 1/5 of strokes in young patients. Case Presentation: A male in his 30s presented to the emergency department with sudden onset of severe vertigo, vomiting, and dizziness while he was playing bowling. The symptoms started when he suddenly twisted his neck while throwing the ball towards pins. Initial diagnosis of central vertigo led to performing plain CT head and CT head angiogram, which demonstrated non-occlusive extradural left vertebral artery dissection. Following CT scans, an MRI head, and MRA head and neck were performed which confirmed the CT diagnosis and also showed left posterior inferior cerebellar artery territory infarcts with micro haemorrhages. The patient was started on dual antiplatelet medications which was continued for 6 months with a follow up MRI/MRA scan of head and neck. Conclusion: This appears to be a unique case where sudden twisting of the neck possibly resulted in vertebral artery dissection and cerebellar infarction. Hence, it is vital to be aware of sports related presentation resulting in sudden neck movements and tear in vertebral artery causing dissection.

A DETAILED REVIEW OF 1000 CASES OF VERTIGO

INTRODUCTION Vertigo is a sensorimotor and multisensory s y n d r o m e w i t h v a r i o u s e t i o l o g i e s a n d pathogenesis, it is not a separate disease process. Early differential diagnosis between peripheral and central vertigo is of prime importance. Pharmacotherapy, rehabilitation, and surgical treatment are the main methods of treatment for vertigo. In the acute phase of attacks, pharmacotherapy is the treatment of choice for vertigo. One of the m o s t i m p o r t a n t m e t h o d s o f v e s t i b u l a r compensation support, required in vertigo treatment after the resolution of acute symptoms is rehabilitation. In patients where there is no improvement after pharmacotherapy, and in cervical, and vascular spine lesions and tumors, surgery may be required. Some patients with vertigo may require multidisciplinary cooperation for successful outcomes. MATERIAL AND METHODS 1000 patients who presented with complaints of dizziness or vertigo from 2014 to 2019 in our Mehrotra ENT Hospital, Kanpur, India were taken for study. After proper history and examination, the patients were subjected to vestibular tests. A proper diagnosis was made after consultation with our neuro equilibrium department and the appropriate maneuver was done. Surgery was performed wherever required. RESULTS 564 were females and 436 were males. Peripheral causes of dizzinessaccount for the majority of dizziness cases with migraine forming the bulk of central cases. Out of 1000 cases, BPPV forms the most number of cases of vertigo accounting for 38.8% of all cases, followed by migraine (21.8%) and Meniere's disease accounting for 13% of all cases. 89.8% of cases were managed conservatively either through maneuvers, medications, and exercises. Rest 9.2% of cases were managed surgically. 0.4% were referred to neuro consultants. Appropriate diagnosis with suitable required maneuvers was key to proper management. CONCLUSION Close multidisciplinary cooperation is essential in dizziness. A well-established neuro equilibrium centre was key to our proper management of vertigo/ dizziness cases. Keywords: vestibular disorder,vertigo, dizziness, Meniere's disease, migraine.

Evaluation of Hematological Parameters in Differentiating Central and Peripheral Vertigo in Patients with Vertigo

Abstract &#x0D; Central and peripheral causes play a role in the etiology of patients who apply to the emergency department with the complaint of vertigo. In our study, in the differential diagnosis of patients with central and peripheral vertigo, the usability of hematological parameters (white blood cell (WBC), leukocyte, neutrophil, lymphocyte, monocytes, basophil, eosinophil and platelet counts, red cell distribution width (RDW), platelet distribution width (PDW)) and platelet/lymphocyte (PLR), neutrophil/lymphocyte (NLR) ratios was investigated. This is a retrospective study including 215 patients, 179 (83.3%)with peripheral vertigo and 36 (16.7%) with central vertigo. Patients who were discharged from the emergency department with the complaint of vertigo or were admitted to the otolaryngology clinic were considered as peripheral vertigo, and patients who had findings on central imaging or were hospitalized in neurology/neurosurgery clinics were considered as central vertigo. There was a statistically significant difference between the groups in terms of age and gender of patients with peripheral and central vertigo (p0.05). We found that the values we looked at were not useful in the differential diagnosis.&#x0D; &#x0D; Öz &#x0D; Acil servise vertigo şikayetiyle başvuran hastaların etiyolojisinde santral ve periferik sebepler rol oynamaktadır. Çalışmamızda santral ve periferik vertigolu hastaların ayırıcı tanısında hematolojik parametrelerin(beyaz küre, lökosit, nötrofil, lenfosit, monosit, bazofil, eozinofil ve trombosit sayıları, kırmızı küre dağılım genişliği (RDW), platelet dağılım genişliği (PDW)), ve platelet/lenfosit, nötrofil/lenfosit oranlarının kullanılabilirliği araştırıldı. Bu çalışma 179’u (%83.3) periferik vertigo, 36’sı (%16.7) santal vertigo olan toplam 215 hastanın dahil edildiği retrospektif bir çalışmadır. Acil servise vertigo şikayetiyle başvurup taburcu edilen ya da kulak burun boğaz kliniğine yatırılan hastalar periferik vertigo olarak, santral görüntülemelerde bulgusu olan ya da nöroloji/nöroşirurji kliniklerine yatırılan hastalar santral vertigo olarak kabul edildi. Periferik ve santral vertigolu hastaların yaş ve cinsiyet durumları bakımından gruplar arasında istatistiksel olarak anlamlı fark saptandı(p0.05). Baktığımız değerlerin ayırıcı tanıda faydalı olmadığını saptadık.

Vertigo as a Problem in the Emergency Department

Objectives: To assess patients with vertigo who came to the emergency department Design: Cross-sectional study. Setting(s): Emergency department of Imam Reza Hospital, Tabriz, Iran. Participants: 280 patients admitted to the emergency department with a complaint of vertigo. Outcome measures: The relationship between age, gender, previous medical history, computerized tomography (CT) scan, and magnetic resonance imaging (MRI) findings were investigated in this study. Results: Vertigo was the most common complaint among emergency department visitors, accounting for 2.1% of all visits. Furthermore, 30.3 % (85 of 280) of all patients with vertigo were identified with central vertigo. The average age of central vertigo patients was 65.9±10.9. Females made up 58.6% and 41.2% of all vertigo patients and central vertigo patients, respectively. In the group with central vertigo, hypertension (HTN) was the most common risk factor (44.7%). Conclusions: Patients who refer to the emergency department with vertigo often do not respond to the usual treatments, and this is the main reason for them to visit the emergency department, so a good history and complete examination along with a suitable imaging modality can help assess these patients.

Case Report: Cerebellar Stroke with Acute Vestibular Syndrome

The posterior circulation accounts for around 20% of cerebral ischemic strokes. According to estimates, 20% of these individuals appear with solitary vertigo. This symptom is incorrectly classified as peripheral vestibular in roughly one-sixth to one-third of these patients [1]. As a result, therapeutic and secondary preventive treatment is deferred from these missing stroke patients, potentially resulting in avoidable morbidity and mortality. Based on a careful evaluation of the literature, we suggest a diagnostic method for clinical differentiating of individuals with acute vestibular syndrome [2]. A stroke involving the inferior cerebellum must be recognized because it can cause cerebellar enlargement, which can lead to brain stem compression and death unless surgery is performed [1]. We report a case of 45-year-old female who had vertigo for 4-5 months and it is not associated with vomiting and posture or climate change, imbalance while walking for 6 months. She is known case of diabetes for 2 years with ongoing Antidiabetic treatment. Evaluating a central origin vertigo or dizziness is the main consequence here.

Vertigo and dizziness in children: When to consider a neurological cause

Vertigo is common in childhood and adolescence. Although children and adults share common causes of vertigo, epidemiology changes with aging. For instance, ischemic stroke is less frequent in childhood, whereas audiovestibular disorders, such as vestibular neuritis and the migraine equivalent, are the leading causes of vertigo. However, even if severe causes of vertigo are rare, clinicians must not miss them. In this review, we discuss the neurological causes of central vertigo in children. The diagnostic approaches reviewed here are focused on the search for signs of severity, such as an abrupt onset, infectious context, or intracranial hypertension, which may subsequently require brain imaging.

Starting point for improving the approach to vertigo in primary care.

Benign paroxysmal positional vertigo (BPPV) is a prevalent and disabling pathology. Its diagnosis and treatment according to clinical practice guidelines is carried out through canalicular repositioning maneuvers, but these maneuvers are not performed routinely in primary care consultations. To analyse the baseline data from the VERTAP randomised community trial that evaluates whether a blended course is effective in improving the adherence of primary care physicians to clinical practice guidelines. Baseline data 2021. 20 primary healthcare centers with an assigned population of 514157. sex, age, diagnoses related to vertigo/dizziness, anti-vertigo medications prescribed, number of referrals to the otolaryngologist and neurologist, complementary examinations, and sick leave. Vertigo/dizziness-related diagnoses totaled 21 359 cases, with a prevalence of 4.15%. Women made up 51.49% of cases. Median age was 52.00 (41.00, 65.00) years. Non-specific diagnoses totaled 18 617 (87.16%), including dizziness (n = 13 846, 64.83%), unspecified vestibular function disorder (n = 962, 4.50%), aural vertigo (n = 7, 0.03%), and other (n = 3802, 17.80%). Specific diagnoses totalled 2742 (12.84%), including BPPV (n = 1665, 7.80%), vestibular neuritis (n = 24, 0.11%), Menière's disease (n = 992, 4.64%), and central vertigo (n = 61, 0.29%). Anti-vertigo drugs prescribed included betahistine (n = 13 338, 62.45%), sulpiride (n = 3379, 15.82%), and dimenhydrinate (n = 20, 0.093%). Complementary examinations included computed tomography (n = 5704, 26.70%) and magnetic resonance (n = 604, 2.83%). One temporary disability for work (n = 1468, 6.87%); ≥2 temporary disability for work (n = 275, 1.29%). The majority of diagnostic records related to vertigo/dizziness were non-specific (9 out of 10). The number of prescriptions for betahistine, and referrals, mainly to an otolaryngologist, are considerable and an avoidable expense. Better knowledge about vertigo/dizziness in care could improve the diagnostic and therapeutic accuracy of this pathology as well as the social and health costs it produces.