ILearnEM

Vertigo and Dizziness

Vertigo and Dizziness

 

Definitions:1

  • “Vertigo is the perception of movement rotation or otherwise where no movement exists.”
  • “Syncope is a transient loss of consciousness accompanied by loss of postural tone with spontaneous recovery.”
  • “Near syncope is lightheadedness with concern for impending loss of consciousness.”
  • “Disequilibrium refers to a feeling of unsteadiness, imbalance, or a sensation of “floating“ while walking.”

 

Vertigo

“The central nervous system coordinates and integrates sensory input from the visual, vestibular, and proprioceptive systems. The three streams of information help to form an impression for the orientation of the head and body as well as the perception of motion. Vertigo arises from mismatch information from two or more of the involved senses, which, in turn, can be caused by dysfunction in the sensory organ or the corresponding pathway.”1

 

Vertigo can be categorized as “peripheral” or “central”:

  • “PERIPHERAL vertigo is caused by disorders affecting the vestibular apparatus and the eight cranial nerve.”1
    • Disorders causing peripheral vertigo:
      • Benign paroxysmal positional vertigo
      • Ménière’s disease
      • Perilymph fistula
      • Vestibular neuronitis
      • Vestibular ganglionitis
      • Labyrinthitis
      • Ototoxicity
      • Eighth nerve lesions
      • Cerebellopontine angle tumors
      • Post traumatic vertigo
      • Vertigo after cochlear implantation

 

  • CENTRAL vertigo is caused by disorders affecting central structures, such as the brainstem and cerebellum.”1
    • Disorders causing central vertigo:

 

A simplified approach to the patient presenting with dizziness can assist with attempting to locate the source of the symptoms.  

 

Click HERE for a list of all mentioned FOAM resources.

 

  1. Goldman, B., Chapter 164, “Vertigo and Dizziness”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 7th ed. McGraw-Hill Education, 2010.

 

Prepared by Alex Mungham PGY1 FM – University of Ottawa