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Neurologic Origins of Dizziness & Vertigo

Neurologic Origins of Dizziness & Vertigo. Clinical presentations of Dizziness or Vertigo that is of Neurologic Origin. Neurologically mediated dizziness can be reported as: Presyncope Disequilibrium True Vertigo Confusion or disorientation.

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Neurologic Origins of Dizziness & Vertigo

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  1. Neurologic Origins of Dizziness & Vertigo

  2. Clinical presentations of Dizziness or Vertigo that is of Neurologic Origin • Neurologically mediated dizziness can be reported as: • Presyncope • Disequilibrium • True Vertigo • Confusion or disorientation

  3. Characteristics of Neurologically Mediated Dizziness • Episodic • Multiple sclerosis • Migraine aura • Auras of seizure disorders • Posterior cerebral circulation transient ischemic attacks • Unremitting & progressively worsening dizziness • Brain tumor

  4. Characteristics of Neurologically Mediated Dizziness • Sudden onset in patient with risk of atherosclerosis • Thromboembolism to the vertebal or basilar artery • Movement or position-provoked dizziness • Presyncope when rising from supine position – orthostatic hypotension • Presyncope from lateral neck rotation – carotid sinus hypersensitivity syndrome

  5. the Diagnostic Workup • Nature and extent of diagnostic workup depend on the differential and provisional diagnoses • History & physical examination • Imaging studies • VNG, rotational chair testing, and posturography • Cardiovascular evaluation • Electroencephalogram (EEG)

  6. Special Neurologic Conditions Associated with Dizziness or Vertigo • Cerebrovascular disease • Multiple sclerosis • Paraneoplastic neurological syndromes • Migraine • Mal de Débarquement • Spinocerebellar and episodic ataxias • Autonomic insufficiency • Postconcussive syndrome • Medication- and substance-induced dizziness

  7. 1. Cerebrovascular disease - STROKE • Sudden onset of neurologic deficit that is caused by: • Hemorrhage (hemorrhagic stroke) • Cessation of blood flow to a brain region (ischemic stroke) • Related to cerebrovascular atherosclerosis, vertebrobasilar insufficiency (VBI) • Can cause permanent or transient damage to the brain

  8. 1. Cerebrovascular disease - STROKE • Effects when the cerebellum, vestibular nuclei, & connections are damaged: • Dizziness, vertigo, or unsteadiness • Diplopia, dysarthria, bilateral weakness, nausea, abrupt onset • Duration: • Few minutes with transient ischemic attacks • Days to months with permanent ischemia

  9. 2. Multiple Sclerosis • Chronic illness characterized by recurrent episodes of demyelination of nerve fibers in the CNS • Symptoms: • Fatigue • Visual deficits • Numbness • Vertigo or unsteadiness • Dysarthria • Facial nerve pain • Treatment for episodic vertigo – vestibular suppressant (meclizine or diazepam)

  10. 3. Paraneoplastic Neurologic Syndromes • Remote effects of cancer on the • CNS, • Peripheral nervous system, • Autonomic nervous system, and • Muscles • Partially triggered by autoimmune processes

  11. 3. Paraneoplastic Neurologic Syndromes • Paraneoplasticcerebellar degeneration • Most often caused by gynecologic malignancy, lung carcinoma, Hodgkin’s lymphoma • Patients may present with: • Probable VNG findings:

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