Causes of Peripheral and Central Vertigo
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less than 30 seconds), positional, fatigable episodes; more often in older adults.
2. Vestibular neuritis/ labyrinthitis - Vertigo may develop suddenly or evolve over several hours, usually increasing in intensity for hours, then gradually subsiding over several days but can last weeks. Can be worsened with positional change. Sometimes history of viral infection precedes initial attack. Highest incidence is found in third and fifth decades.
3. Méniére's disease - Recurrent episodes of severe rotational vertigo usually lasting hours. Onset usually abrupt. Attacks may occur in clusters. Long symptom-free remissions.
1. Vascular disorders
A. Vertebrobasilar insufficiency (VBI) - Should be considered in any patient of advanced age with isolated new-onset vertigo without an obvious cause. More likely with history of atherosclerosis. Can occur with neck trauma. May be preceded by an episode usually lasting minutes.
B. Cerebellar hemorrhage - Sudden onset of severe symptoms.
C. Occlusion of posterior inferior cerebellar artery (Wallenberg's syndrome) - Vertigo associated with significant neurologic complaints.
2. Head trauma - Symptoms begin with or shortly after head trauma. Positional symptoms most common type after trauma. Self-limited symptoms that can persist weeks to months.
3. Migrainous vertigo - Vertigo attacks can occur during the headache (in one study of 33 patients 24% always had headache with vertigo and 67% had headache sometimes with vertigo) but often occur during the headache-free interval. Most patients have a family history of migraine. Syndrome usually begins in adolescence.
4. Multiple sclerosis - Vertigo presenting symptom in 7% to 10% and appears in the course of the disease in a third. Onset may be severe. Disease onset usually between ages of 20 and 40. Often history of other attacks with varying neurologic signs or symptoms.
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