Vertigo is the third most common presenting symptom in neurological practice.
As a symptom it has a wide spectrum of etiologies,
and is often misintrepreted,
leading to unnecessary (radiological) inverstigations.
This poster serves as an aid for the radiologist in that it presents pertinent clinical,
anamnestic and differential diagnostic information which will help in choosing a proper diagnostic pathway.
illusion of movement
• self in space
• space around self:
• „in an elevator“ / vertical
• „on a carrousel“ / rotatory
• „seesaw “ / lateralising
• „on waves“ / undulating
classification
peripheral -
1.
benign paroxysmal
positional vertigo / BPPV
2.
Menière’s disease
3.
vestibular neuritis
4.
bilateral vestibulopathy
5.
perilymph fistula
central -
1.
central-vestibular vertigo
2.
basilar/vestibular migraine
3.
vestibular paroxysm
other -
1.
phobic vertigo
2.
psychogenic vertigo
3.
undefined vertigo sydromes
causes
• banal to fatal
- brain stem symptoms indicate a central cause!
- first vertigo,
then LOC → EMERGENCY!
peripheral vs.
central symptoms
- peripheral -
inner ear - tinnitus,
hearing loss,
otalgia
vertigo - rotatory
nystagmus - rotatory,
+ fatiguing/ latency
VOR/Halmagyi - positive
vegetative sx - nausea,
vomiting
- central -
brain stem - diplopia,
dysarthria,
dysphagia
cerebellum - dysmetria,
ataxia
vertigo - lateralising
nystagmus - vertical,
gaze-evoked,
no fatiguing or latency
VOR/Halmagyi - negative
raised ICP – cephalgia,
vomiting,
LOC
clinico-anamnestic differential diagnoses
• subjective („What the patient says.“):
• light-headedness,
confusion,
nausea,
weakness ...
• objective („What the patient means!“):
• syncope,
delirium,
pareses,
dysaesthesia (dorsal column),
ataxia,dementia
timeline
- singular,
sudden: ICB,
ischaemia
- protracted,
relapsing/remitting: MS,
tumour,
infection,
medication side effect
- (more or less) sudden,
recurrent: Menière’s disease,
BPPV
Author's note -
The poster was originally presented at the DRG 2012 in Hamburg.
It is being re-presented at ECR 2013 by request.
Unfortunately,
the format afforded by EPOS is inadequate to show the poster in its original form,
as is indicated in figure 4.
Any reader interested in a copy of the original presentation can contact me: [email protected].