Vertigo differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Vertigo is one of the four type of [[dizziness]], therefore it must be differentiated from other forms of [[dizziness]], [[presyncope]], [[lightheadedness]] and [[disequilibrium]].<ref name="Derebery1999">{{cite journal|last1=Derebery|first1=M. Jennifer|title=THE DIAGNOSIS AND TREATMENT OF DIZZINESS|journal=Medical Clinics of North America|volume=83|issue=1|year=1999|pages=163–177|issn=00257125|doi=10.1016/S0025-7125(05)70095-X}}</ref>
Many disease cause vertigo as a symptom, following diseases must be investigated as a differential diagnosis for vertigo symptom: [[Vestibular neuritis]], [[Herpes simplex virus|HSV]] oticus, [[Ménière's disease|Meniere disease]], labyrinrhine [[concussion]], [[Perilymph fistula|perilymphatic fistula]], [[semicircular canal]] dehiscence syndrome, [[Vestibular system|vestibular]] paroxysmia, [[Cogan syndrome]], [[vestibular schwannoma]], [[otitis media]], [[aminoglycoside]] toxicity, recurrent vestibulopathy, vestibular [[migraine]], [[epileptic]] [[vertigo]], [[multiple sclerosis]], [[Brain tumor|brain tumors]], [[cerebellar infarction]]/[[hemorrhage]], [[brain stem]] [[ischemia]], [[Arnold-Chiari malformation|chiari malformation]], and [[Parkinson's disease|Parkinson]].


==Differentiating Vertigo from Other Diseases==
==Differentiating Vertigo from Other Diseases==
*Many disease cause vertigo as a symptom, following diseases must be investigated as a differential diagnosis for vertigo symptom:<ref name="pmid16445269">{{cite journal| author=Labuguen RH| title=Initial evaluation of vertigo. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 2 | pages= 244-51 | pmid=16445269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16445269  }} </ref>
===Differentiating vertigo from other diseases ===
**[[Acoustic neuroma]]
**[[Acute]] [[anemia]]
**[[Anxiety]] disorders
**[[Benign Paroxysmal Positional Vertigo]]
**Brain [[tumors]]
**[[Brainstem Stroke]]
**[[Cerebellopontine angle tumor]]
**[[Chiari malformation]]
**[[Cholesteatoma]]
**Chronic [[anemia]]
**[[Giant cell arteritis]]
**Herpes zoster oticus ([[Ramsay-Hunt Syndrome]]
**[[Labyrinthitis]]
**[[Lateral medullary syndrome]]
**[[Mastoiditis]]
**Medication induced
**[[Ménière disease]]
**[[Meningitis]]
**[[Migraine]] [[headache]]
**[[Multiple sclerosis]]
**[[Otosclerosis]]
**[[Perilymphatic fistula]]
**[[Vertebrobasilar atherothrombotic disease]]
**[[Vestibular neuronitis]]
**[[Wernicke encephalopathy]]


BPPV must be differentiated from other [[Disease|diseases]] that cause [[vertigo]], [[nystagmus]], and [[Hearing impairment|hearing problems]], such as [[Vestibular neuronitis|vestibular neuritis]], [[Herpes simplex virus|HSV]] oticus, [[Ménière's disease|Meniere disease]], labyrinrhine [[concussion]], [[Perilymph fistula|perilymphatic fistula]], [[semicircular canal]] dehiscence syndrome, [[Vestibular system|vestibular]] paroxysmia, [[Cogan syndrome]], [[vestibular schwannoma]], [[otitis media]], [[aminoglycoside]] toxicity, recurrent vestibulopathy, vestibular [[migraine]], [[epileptic]] [[vertigo]], [[multiple sclerosis]], [[Brain tumor|brain tumors]], [[cerebellar infarction]]/[[hemorrhage]], [[brain stem]] [[ischemia]], [[Arnold-Chiari malformation|chiari malformation]], and [[Parkinson's disease|Parkinson]].
Many disease cause vertigo as a symptom, following diseases must be investigated as a differential diagnosis for vertigo symptom: [[Vestibular neuritis]], [[Herpes simplex virus|HSV]] oticus, [[Ménière's disease|Meniere disease]], labyrinrhine [[concussion]], [[Perilymph fistula|perilymphatic fistula]], [[semicircular canal]] dehiscence syndrome, [[Vestibular system|vestibular]] paroxysmia, [[Cogan syndrome]], [[vestibular schwannoma]], [[otitis media]], [[aminoglycoside]] toxicity, recurrent vestibulopathy, vestibular [[migraine]], [[epileptic]] [[vertigo]], [[multiple sclerosis]], [[Brain tumor|brain tumors]], [[cerebellar infarction]]/[[hemorrhage]], [[brain stem]] [[ischemia]], [[Arnold-Chiari malformation|chiari malformation]], and [[Parkinson's disease|Parkinson]].<ref name="pmid16445269">{{cite journal| author=Labuguen RH| title=Initial evaluation of vertigo. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 2 | pages= 244-51 | pmid=16445269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16445269 }} </ref>
 
==Differentiating BPPV from other Diseases==
BPPV must be differentiated from other [[Disease|diseases]] that cause [[vertigo]], [[nystagmus]], and [[Hearing impairment|hearing problems]], such as [[Vestibular neuronitis|vestibular neuritis]], [[Herpes simplex virus|HSV]] oticus, [[Ménière's disease|Meniere disease]], labyrinrhine [[concussion]], [[Perilymph fistula|perilymphatic fistula]], [[semicircular canal]] dehiscence syndrome, [[Vestibular system|vestibular]] paroxysmia, [[Cogan syndrome]], [[vestibular schwannoma]], [[otitis media]], [[aminoglycoside]] toxicity, recurrent vestibulopathy, vestibular [[migraine]], [[epileptic]] [[vertigo]], [[multiple sclerosis]], [[Brain tumor|brain tumors]], [[cerebellar infarction]]/[[hemorrhage]], [[brain stem]] [[ischemia]], [[Arnold-Chiari malformation|chiari malformation]], and [[Parkinson's disease|Parkinson]].
 
===Differentiating BPPV from other diseases on the basis of vertigo, nystagmus, and hearing problems===
 
On the basis of [[Vertigo MRI|vertigo]], [[nystagmus]], and [[Hearing impairment|hearing problems]], BPPV must be differentiated from [[Vestibular neuronitis|vestibular neuritis]], [[Herpes simplex virus|HSV]] oticus, [[Ménière's disease|Meniere disease]], labyrinrhine [[concussion]], [[Perilymph fistula|perilymphatic fistula]], [[semicircular canal]] dehiscence syndrome, [[Vestibular system|vestibular]] paroxysmia, [[Cogan syndrome]], [[vestibular schwannoma]], [[otitis media]], [[aminoglycoside]] toxicity, recurrent vestibulopathy, vestibular [[migraine]], [[epileptic]] [[vertigo]], [[multiple sclerosis]], [[Brain tumor|brain tumors]], [[cerebellar infarction]]/[[hemorrhage]], [[brain stem]] [[ischemia]], [[Arnold-Chiari malformation|chiari malformation]], and [[Parkinson's disease|Parkinson]].
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Recurrency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Recurrency
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nystagmus
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nystagmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hearing problems  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hearing problems
|-
|-
| colspan="10" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |'''Peripheral'''
| colspan="10" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |'''Peripheral'''
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* + [[Dix-Hallpike test|Dix-Hallpike maneuver]]
*+ [[Dix-Hallpike test|Dix-Hallpike maneuver]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Dix-Hallpike test|Dix-Hallpike maneuver]]
*[[Dix-Hallpike test|Dix-Hallpike maneuver]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May be associated with [[nausea]], [[vomiting]], and [[Gait abnormality|gait instability]]
*May be associated with [[nausea]], [[vomiting]], and [[Gait abnormality|gait instability]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vestibular neuronitis|Vestibular neuritis]]<br><ref name="pmid18283159">{{cite journal |vauthors=Mandalà M, Nuti D, Broman AT, Zee DS |title=Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis |journal=Arch. Otolaryngol. Head Neck Surg. |volume=134 |issue=2 |pages=164–9 |date=February 2008 |pmid=18283159 |doi=10.1001/archoto.2007.35 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vestibular neuronitis|Vestibular neuritis]]<br><ref name="pmid18283159">{{cite journal |vauthors=Mandalà M, Nuti D, Broman AT, Zee DS |title=Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis |journal=Arch. Otolaryngol. Head Neck Surg. |volume=134 |issue=2 |pages=164–9 |date=February 2008 |pmid=18283159 |doi=10.1001/archoto.2007.35 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* + Head thrust test
*+ Head thrust test
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May be associated with [[nausea]], [[vomiting]], [[Gait abnormality|gait instability]] and previous [[upper respiratory infection]]
*May be associated with [[nausea]], [[vomiting]], [[Gait abnormality|gait instability]] and previous [[upper respiratory infection]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ramsay Hunt syndrome type II|HSV oticus]]<br><ref name="Wackym1997">{{cite journal|last1=Wackym|first1=Phillip A.|title=Molecular Temporal Bone Pathology: II. Ramsay Hunt Syndrome (Herpes Zoster Oticus)|journal=The Laryngoscope|volume=107|issue=9|year=1997|pages=1165–1175|issn=0023852X|doi=10.1097/00005537-199709000-00003}}</ref><ref name="ZhuPyatkevich2014">{{cite journal|last1=Zhu|first1=S.|last2=Pyatkevich|first2=Y.|title=Ramsay Hunt syndrome type II|journal=Neurology|volume=82|issue=18|year=2014|pages=1664–1664|issn=0028-3878|doi=10.1212/WNL.0000000000000388}}</ref><ref name="pmid2113244">{{cite journal |vauthors=Mishell JH, Applebaum EL |title=Ramsay-Hunt syndrome in a patient with HIV infection |journal=Otolaryngol Head Neck Surg |volume=102 |issue=2 |pages=177–9 |date=February 1990 |pmid=2113244 |doi=10.1177/019459989010200215 |url=}}</ref><ref name="TadaAoyagi2009">{{cite journal|last1=Tada|first1=Yuichiro|last2=Aoyagi|first2=Masaru|last3=Tojima|first3=Hitoshi|last4=Inamura|first4=Hiroo|last5=Saito|first5=Osamu|last6=Maeyama|first6=Hiroyuki|last7=Kohsyu|first7=Hidehiro|last8=Koike|first8=Yoshio|title=Gd-DTPA Enhanced MRI in Ramsay Hunt Syndrome|journal=Acta Oto-Laryngologica|volume=114|issue=sup511|year=2009|pages=170–174|issn=0001-6489|doi=10.3109/00016489409128326}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ramsay Hunt syndrome type II|HSV oticus]]<br><ref name="Wackym1997">{{cite journal|last1=Wackym|first1=Phillip A.|title=Molecular Temporal Bone Pathology: II. Ramsay Hunt Syndrome (Herpes Zoster Oticus)|journal=The Laryngoscope|volume=107|issue=9|year=1997|pages=1165–1175|issn=0023852X|doi=10.1097/00005537-199709000-00003}}</ref><ref name="ZhuPyatkevich2014">{{cite journal|last1=Zhu|first1=S.|last2=Pyatkevich|first2=Y.|title=Ramsay Hunt syndrome type II|journal=Neurology|volume=82|issue=18|year=2014|pages=1664–1664|issn=0028-3878|doi=10.1212/WNL.0000000000000388}}</ref><ref name="pmid2113244">{{cite journal |vauthors=Mishell JH, Applebaum EL |title=Ramsay-Hunt syndrome in a patient with HIV infection |journal=Otolaryngol Head Neck Surg |volume=102 |issue=2 |pages=177–9 |date=February 1990 |pmid=2113244 |doi=10.1177/019459989010200215 |url=}}</ref><ref name="TadaAoyagi2009">{{cite journal|last1=Tada|first1=Yuichiro|last2=Aoyagi|first2=Masaru|last3=Tojima|first3=Hitoshi|last4=Inamura|first4=Hiroo|last5=Saito|first5=Osamu|last6=Maeyama|first6=Hiroyuki|last7=Kohsyu|first7=Hidehiro|last8=Koike|first8=Yoshio|title=Gd-DTPA Enhanced MRI in Ramsay Hunt Syndrome|journal=Acta Oto-Laryngologica|volume=114|issue=sup511|year=2009|pages=170–174|issn=0001-6489|doi=10.3109/00016489409128326}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Taste loss in the front two-thirds of the [[tongue]]
*Taste loss in the front two-thirds of the [[tongue]]
* [[Acute facial nerve paralysis]]
*[[Acute facial nerve paralysis]]
* [[Vesicles]] in the [[ear canal]], the [[tongue]], and/or [[hard palate]]
*[[Vesicles]] in the [[ear canal]], the [[tongue]], and/or [[hard palate]]


| style="background: #F5F5F5; padding: 5px; text-align: center;" | + [[Varicella zoster virus|VZV]] antibody titres
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + [[Varicella zoster virus|VZV]] antibody titres
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In [[Magnetic resonance imaging|MRI]] with [[gadolinium]] dye we may have enhancement of the [[facial nerve]] and [[cranial nerve VIII]]
*In [[Magnetic resonance imaging|MRI]] with [[gadolinium]] dye we may have enhancement of the [[facial nerve]] and [[cranial nerve VIII]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May be associated with [[otalgia]], [[dry mouth]], and [[dry eyes]]
*May be associated with [[otalgia]], [[dry mouth]], and [[dry eyes]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ménière's disease|Meniere disease]]<br><ref name="Watanabe1980">{{cite journal|last1=Watanabe|first1=Isamu|title=Ménière’s Disease|journal=ORL|volume=42|issue=1-2|year=1980|pages=20–45|issn=1423-0275|doi=10.1159/000275477}}</ref><ref name="pmid9487176">{{cite journal |vauthors=Saeed SR |title=Fortnightly review. Diagnosis and treatment of Ménière's disease |journal=BMJ |volume=316 |issue=7128 |pages=368–72 |date=January 1998 |pmid=9487176 |pmc=2665527 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ménière's disease|Meniere disease]]<br><ref name="Watanabe1980">{{cite journal|last1=Watanabe|first1=Isamu|title=Ménière’s Disease|journal=ORL|volume=42|issue=1-2|year=1980|pages=20–45|issn=1423-0275|doi=10.1159/000275477}}</ref><ref name="pmid9487176">{{cite journal |vauthors=Saeed SR |title=Fortnightly review. Diagnosis and treatment of Ménière's disease |journal=BMJ |volume=316 |issue=7128 |pages=368–72 |date=January 1998 |pmid=9487176 |pmc=2665527 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | + (Progressive)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + (Progressive)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Sensorineural hearing loss]]
*[[Sensorineural hearing loss]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see small or invisible [[vestibular aqueduct]]
*In [[CT scan]] we may see small or invisible [[vestibular aqueduct]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]/ Rulling out other diagnoses
*[[History and Physical examination|History/ Physical exam]]/ Rulling out other diagnoses
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May be associated with [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]], and [[tinnitus]]
*May be associated with [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]], and [[tinnitus]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Labyrinthine concussion<br><ref name="DürrerPoláčková1971">{{cite journal|last1=Dürrer|first1=J.|last2=Poláčková|first2=J.|title=Labyrinthine Concussion|journal=ORL|volume=33|issue=3|year=1971|pages=185–190|issn=1423-0275|doi=10.1159/000274994}}</ref><ref name="pmid24653897">{{cite journal |vauthors=Choi MS, Shin SO, Yeon JY, Choi YS, Kim J, Park SK |title=Clinical characteristics of labyrinthine concussion |journal=Korean J Audiol |volume=17 |issue=1 |pages=13–7 |date=April 2013 |pmid=24653897 |pmc=3936518 |doi=10.7874/kja.2013.17.1.13 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Labyrinthine concussion<br><ref name="DürrerPoláčková1971">{{cite journal|last1=Dürrer|first1=J.|last2=Poláčková|first2=J.|title=Labyrinthine Concussion|journal=ORL|volume=33|issue=3|year=1971|pages=185–190|issn=1423-0275|doi=10.1159/000274994}}</ref><ref name="pmid24653897">{{cite journal |vauthors=Choi MS, Shin SO, Yeon JY, Choi YS, Kim J, Park SK |title=Clinical characteristics of labyrinthine concussion |journal=Korean J Audiol |volume=17 |issue=1 |pages=13–7 |date=April 2013 |pmid=24653897 |pmc=3936518 |doi=10.7874/kja.2013.17.1.13 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[high frequency hearing loss]]
*[[high frequency hearing loss]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* We may see other evidences of [[head trauma]] or [[temporal bone]] [[fracture]]
*We may see other evidences of [[head trauma]] or [[temporal bone]] [[fracture]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* It happens following blunt [[head trauma]]
*It happens following blunt [[head trauma]]
* May be associated with [[dizziness]] or [[tinnitus]]
*May be associated with [[dizziness]] or [[tinnitus]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Perilymphatic fistula]]<br><ref name="FoxBalkany1988">{{cite journal|last1=Fox|first1=Eileen J.|last2=Balkany|first2=Thomas J.|last3=Arenberg|first3=Kaufman|title=The Tullio Phenomenon and Perilymph Fistula|journal=Otolaryngology–Head and Neck Surgery|volume=98|issue=1|year=1988|pages=88–89|issn=0194-5998|doi=10.1177/019459988809800115}}</ref><ref name="pmid11796947">{{cite journal |vauthors=Casselman JW |title=Diagnostic imaging in clinical neuro-otology |journal=Curr. Opin. Neurol. |volume=15 |issue=1 |pages=23–30 |date=February 2002 |pmid=11796947 |doi= |url=}}</ref><ref name="pmid3941579">{{cite journal |vauthors=Seltzer S, McCabe BF |title=Perilymph fistula: the Iowa experience |journal=Laryngoscope |volume=96 |issue=1 |pages=37–49 |date=January 1986 |pmid=3941579 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Perilymphatic fistula]]<br><ref name="FoxBalkany1988">{{cite journal|last1=Fox|first1=Eileen J.|last2=Balkany|first2=Thomas J.|last3=Arenberg|first3=Kaufman|title=The Tullio Phenomenon and Perilymph Fistula|journal=Otolaryngology–Head and Neck Surgery|volume=98|issue=1|year=1988|pages=88–89|issn=0194-5998|doi=10.1177/019459988809800115}}</ref><ref name="pmid11796947">{{cite journal |vauthors=Casselman JW |title=Diagnostic imaging in clinical neuro-otology |journal=Curr. Opin. Neurol. |volume=15 |issue=1 |pages=23–30 |date=February 2002 |pmid=11796947 |doi= |url=}}</ref><ref name="pmid3941579">{{cite journal |vauthors=Seltzer S, McCabe BF |title=Perilymph fistula: the Iowa experience |journal=Laryngoscope |volume=96 |issue=1 |pages=37–49 |date=January 1986 |pmid=3941579 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Tullio phenomenon]]
*[[Tullio phenomenon]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[CT scan]] may show fluid around the round window recess
*[[CT scan]] may show fluid around the round window recess
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]/[[Imaging]]
*[[History and Physical examination|History/ Physical exam]]/[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Can be a complication of a [[stapedectomy]], [[head injury]], or heavy lifting
*Can be a complication of a [[stapedectomy]], [[head injury]], or heavy lifting
* It may be provoked by [[Sneeze|sneezing]], lifting, straining, [[Cough|coughing]], and loud sounds
*It may be provoked by [[Sneeze|sneezing]], lifting, straining, [[Cough|coughing]], and loud sounds
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Semicircular canal  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Semicircular canal  
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(air-bone gaps on audiometry)
(air-bone gaps on audiometry)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Tullio phenomenon]]
*[[Tullio phenomenon]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[CT scan]] may show defect in the arcuate eminence of the [[superior semicircular canal]]
*[[CT scan]] may show defect in the arcuate eminence of the [[superior semicircular canal]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]/[[Imaging]]
*[[History and Physical examination|History/ Physical exam]]/[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* It may be provoked by [[Valsalva maneuver]], [[Cough|coughing]], and [[Sneeze|sneezing]]
*It may be provoked by [[Valsalva maneuver]], [[Cough|coughing]], and [[Sneeze|sneezing]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Vestibular paroxysmia<br><ref name="HufnerBarresi2008">{{cite journal|last1=Hufner|first1=K.|last2=Barresi|first2=D.|last3=Glaser|first3=M.|last4=Linn|first4=J.|last5=Adrion|first5=C.|last6=Mansmann|first6=U.|last7=Brandt|first7=T.|last8=Strupp|first8=M.|title=Vestibular paroxysmia: Diagnostic features and medical treatment|journal=Neurology|volume=71|issue=13|year=2008|pages=1006–1014|issn=0028-3878|doi=10.1212/01.wnl.0000326594.91291.f8}}</ref><ref name="pmid23400324">{{cite journal |vauthors=Strupp M, von Stuckrad-Barre S, Brandt T, Tonn JC |title=Teaching neuroimages: Compression of the eighth cranial nerve causes vestibular paroxysmia |journal=Neurology |volume=80 |issue=7 |pages=e77 |date=February 2013 |pmid=23400324 |doi=10.1212/WNL.0b013e318281cc2c |url=}}</ref><ref name="pmid18809837">{{cite journal |vauthors=Hüfner K, Barresi D, Glaser M, Linn J, Adrion C, Mansmann U, Brandt T, Strupp M |title=Vestibular paroxysmia: diagnostic features and medical treatment |journal=Neurology |volume=71 |issue=13 |pages=1006–14 |date=September 2008 |pmid=18809837 |doi=10.1212/01.wnl.0000326594.91291.f8 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Vestibular paroxysmia<br><ref name="HufnerBarresi2008">{{cite journal|last1=Hufner|first1=K.|last2=Barresi|first2=D.|last3=Glaser|first3=M.|last4=Linn|first4=J.|last5=Adrion|first5=C.|last6=Mansmann|first6=U.|last7=Brandt|first7=T.|last8=Strupp|first8=M.|title=Vestibular paroxysmia: Diagnostic features and medical treatment|journal=Neurology|volume=71|issue=13|year=2008|pages=1006–1014|issn=0028-3878|doi=10.1212/01.wnl.0000326594.91291.f8}}</ref><ref name="pmid23400324">{{cite journal |vauthors=Strupp M, von Stuckrad-Barre S, Brandt T, Tonn JC |title=Teaching neuroimages: Compression of the eighth cranial nerve causes vestibular paroxysmia |journal=Neurology |volume=80 |issue=7 |pages=e77 |date=February 2013 |pmid=23400324 |doi=10.1212/WNL.0b013e318281cc2c |url=}}</ref><ref name="pmid18809837">{{cite journal |vauthors=Hüfner K, Barresi D, Glaser M, Linn J, Adrion C, Mansmann U, Brandt T, Strupp M |title=Vestibular paroxysmia: diagnostic features and medical treatment |journal=Neurology |volume=71 |issue=13 |pages=1006–14 |date=September 2008 |pmid=18809837 |doi=10.1212/01.wnl.0000326594.91291.f8 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Impaired [[Caloric reflex test|caloric testing]]
*Impaired [[Caloric reflex test|caloric testing]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* We may see evidence of [[vestibulocochlear nerve]] compression on [[MRI]]
*We may see evidence of [[vestibulocochlear nerve]] compression on [[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]/Imaging
*[[History and Physical examination|History/ Physical exam]]/Imaging
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* It may be provoked by head turn or other action
*It may be provoked by head turn or other action
* They respond well to treatment with [[carbamazepine]] or [[oxcarbazepine]]
*They respond well to treatment with [[carbamazepine]] or [[oxcarbazepine]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cogan syndrome]]<br><ref name="pmid2189159">{{cite journal |vauthors=Vollertsen RS |title=Vasculitis and Cogan's syndrome |journal=Rheum. Dis. Clin. North Am. |volume=16 |issue=2 |pages=433–9 |date=May 1990 |pmid=2189159 |doi= |url=}}</ref><ref name="HughesKinney1983">{{cite journal|last1=Hughes|first1=Gordon B.|last2=Kinney|first2=Sam E.|last3=Barna|first3=Barbara P.|last4=Tomsak|first4=Robert L.|last5=Calabrese|first5=Leonard H.|title=Autoimmune reactivity in Cogan's syndrome: A preliminary report|journal=Otolaryngology–Head and Neck Surgery|volume=91|issue=1|year=1983|pages=24–32|issn=0194-5998|doi=10.1177/019459988309100106}}</ref><ref name="MajoorAlbers2009">{{cite journal|last1=Majoor|first1=M. H. J. M.|last2=Albers|first2=F. W. J.|last3=Casselman|first3=J. W.|title=Clinical Relevance of Magnetic Resonance Imaging and Computed Tomography in Cogan's Syndrome|journal=Acta Oto-Laryngologica|volume=113|issue=5|year=2009|pages=625–631|issn=0001-6489|doi=10.3109/00016489309135875}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cogan syndrome]]<br><ref name="pmid2189159">{{cite journal |vauthors=Vollertsen RS |title=Vasculitis and Cogan's syndrome |journal=Rheum. Dis. Clin. North Am. |volume=16 |issue=2 |pages=433–9 |date=May 1990 |pmid=2189159 |doi= |url=}}</ref><ref name="HughesKinney1983">{{cite journal|last1=Hughes|first1=Gordon B.|last2=Kinney|first2=Sam E.|last3=Barna|first3=Barbara P.|last4=Tomsak|first4=Robert L.|last5=Calabrese|first5=Leonard H.|title=Autoimmune reactivity in Cogan's syndrome: A preliminary report|journal=Otolaryngology–Head and Neck Surgery|volume=91|issue=1|year=1983|pages=24–32|issn=0194-5998|doi=10.1177/019459988309100106}}</ref><ref name="MajoorAlbers2009">{{cite journal|last1=Majoor|first1=M. H. J. M.|last2=Albers|first2=F. W. J.|last3=Casselman|first3=J. W.|title=Clinical Relevance of Magnetic Resonance Imaging and Computed Tomography in Cogan's Syndrome|journal=Acta Oto-Laryngologica|volume=113|issue=5|year=2009|pages=625–631|issn=0001-6489|doi=10.3109/00016489309135875}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Interstitial keratitis]]  
*[[Interstitial keratitis]]
* [[Oscillopsia]]
*[[Oscillopsia]]
* Absent [[vestibular function]] on [[Caloric reflex test|caloric test]]
*Absent [[vestibular function]] on [[Caloric reflex test|caloric test]]
* [[Systemic vasculitis]] ([[Aortitis]])
*[[Systemic vasculitis]] ([[Aortitis]])
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Increased [[ESR]] and  [[cryoglobulins]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Increased [[ESR]] and  [[cryoglobulins]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see [[calcification]] or soft tissue attenuation obliterating the intralabyrinthine fluid spaces  
*In [[CT scan]] we may see [[calcification]] or soft tissue attenuation obliterating the intralabyrinthine fluid spaces
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[Ménière's disease|Ménière]]-like attacks
*It may cause [[Ménière's disease|Ménière]]-like attacks
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vestibular schwannoma]]<br><ref>{{Cite journal
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vestibular schwannoma]]<br><ref>{{Cite journal
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Sensorineural hearing loss]]
*[[Sensorineural hearing loss]]
* + [[Rinne test]]
*+ [[Rinne test]]
* Lateralization of [[Weber test]] to the normal [[ear]]
*Lateralization of [[Weber test]] to the normal [[ear]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see erosion, and widening of the [[Internal auditory meatus|internal acoustic meatus]]
*In [[CT scan]] we may see erosion, and widening of the [[Internal auditory meatus|internal acoustic meatus]]
* Hypointense [[mass]] on T1-weighted [[MRI]], and hyperintense [[mass]] on T2-weighted [[MRI]]
*Hypointense [[mass]] on T1-weighted [[MRI]], and hyperintense [[mass]] on T2-weighted [[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Gadolinium]]-enhanced [[MRI]] scan is definitive diagnostic test of [[Vestibular schwannoma|acoutic neuroma]]
*[[Gadolinium]]-enhanced [[MRI]] scan is definitive diagnostic test of [[Vestibular schwannoma|acoutic neuroma]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Otitis media]]<br><ref name="urlEar infection - acute: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm |title=Ear infection - acute: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref><ref name="pmid25213276">{{cite journal |vauthors=Rettig E, Tunkel DE |title=Contemporary concepts in management of acute otitis media in children |journal=Otolaryngol. Clin. North Am. |volume=47 |issue=5 |pages=651–72 |year=2014 |pmid=25213276 |pmc=4393005 |doi=10.1016/j.otc.2014.06.006 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Otitis media]]<br><ref name="urlEar infection - acute: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm |title=Ear infection - acute: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref><ref name="pmid25213276">{{cite journal |vauthors=Rettig E, Tunkel DE |title=Contemporary concepts in management of acute otitis media in children |journal=Otolaryngol. Clin. North Am. |volume=47 |issue=5 |pages=651–72 |year=2014 |pmid=25213276 |pmc=4393005 |doi=10.1016/j.otc.2014.06.006 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Fever
*Fever
* Presence of effusion in the [[middle ear]]
*Presence of effusion in the [[middle ear]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Increased [[Acute phase reactant|acute phase reactants]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Increased [[Acute phase reactant|acute phase reactants]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Opacification of the [[middle ear]]
*Opacification of the [[middle ear]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patient may show other [[signs]] and [[symptoms]] of [[upper respiratory infection]] such az [[cough]], [[nasal discharge]], and [[fever]]
*Patient may show other [[signs]] and [[symptoms]] of [[upper respiratory infection]] such az [[cough]], [[nasal discharge]], and [[fever]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Aminoglycoside toxicity<br><ref name="pmid8597959">{{cite journal |vauthors=Ernfors P, Duan ML, ElShamy WM, Canlon B |title=Protection of auditory neurons from aminoglycoside toxicity by neurotrophin-3 |journal=Nat. Med. |volume=2 |issue=4 |pages=463–7 |date=April 1996 |pmid=8597959 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Aminoglycoside toxicity<br><ref name="pmid8597959">{{cite journal |vauthors=Ernfors P, Duan ML, ElShamy WM, Canlon B |title=Protection of auditory neurons from aminoglycoside toxicity by neurotrophin-3 |journal=Nat. Med. |volume=2 |issue=4 |pages=463–7 |date=April 1996 |pmid=8597959 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Oscillopsia]]
*[[Oscillopsia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May be associated with [[nausea]], [[vomiting]], and [[ataxia]]
*May be associated with [[nausea]], [[vomiting]], and [[ataxia]]
* It may be irreversible
*It may be irreversible
* [[Gentamicin]] is the most common one
*[[Gentamicin]] is the most common one
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Recurrent vestibulopathy<br><ref name="pmid11343320">{{cite journal |vauthors=Oh AK, Lee H, Jen JC, Corona S, Jacobson KM, Baloh RW |title=Familial benign recurrent vertigo |journal=Am. J. Med. Genet. |volume=100 |issue=4 |pages=287–91 |date=May 2001 |pmid=11343320 |doi= |url=}}</ref><ref name="pmid3712538">{{cite journal |vauthors=Rutka JA, Barber HO |title=Recurrent vestibulopathy: third review |journal=J Otolaryngol |volume=15 |issue=2 |pages=105–7 |date=April 1986 |pmid=3712538 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Recurrent vestibulopathy<br><ref name="pmid11343320">{{cite journal |vauthors=Oh AK, Lee H, Jen JC, Corona S, Jacobson KM, Baloh RW |title=Familial benign recurrent vertigo |journal=Am. J. Med. Genet. |volume=100 |issue=4 |pages=287–91 |date=May 2001 |pmid=11343320 |doi= |url=}}</ref><ref name="pmid3712538">{{cite journal |vauthors=Rutka JA, Barber HO |title=Recurrent vestibulopathy: third review |journal=J Otolaryngol |volume=15 |issue=2 |pages=105–7 |date=April 1986 |pmid=3712538 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/ Physical exam]]
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* The underlying [[pathophysiology]] is unknown
*The underlying [[pathophysiology]] is unknown


* It may happen infrequently, every one to two years
*It may happen infrequently, every one to two years
* It may be associated with [[nausea]] and [[vomiting]]
*It may be associated with [[nausea]] and [[vomiting]]
* It may overlap with vestibular [[migraine]]
*It may overlap with vestibular [[migraine]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="10" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Central
! colspan="10" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Central
Line 312: Line 280:
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* History of [[migraine headaches]]
*History of [[migraine headaches]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* They may have [[White matter|white-matter]] hyperintensities (WMHs) on [[MRI]]
*They may have [[White matter|white-matter]] hyperintensities (WMHs) on [[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* ICHD-3 criteria
*ICHD-3 criteria
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* It may be associated with [[anxiety]] and [[depression]]
*It may be associated with [[anxiety]] and [[depression]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epileptic vertigo<br><ref name="pmid25795644">{{cite journal |vauthors=Tarnutzer AA, Lee SH, Robinson KA, Kaplan PW, Newman-Toker DE |title=Clinical and electrographic findings in epileptic vertigo and dizziness: a systematic review |journal=Neurology |volume=84 |issue=15 |pages=1595–604 |date=April 2015 |pmid=25795644 |pmc=4408281 |doi=10.1212/WNL.0000000000001474 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epileptic vertigo<br><ref name="pmid25795644">{{cite journal |vauthors=Tarnutzer AA, Lee SH, Robinson KA, Kaplan PW, Newman-Toker DE |title=Clinical and electrographic findings in epileptic vertigo and dizziness: a systematic review |journal=Neurology |volume=84 |issue=15 |pages=1595–604 |date=April 2015 |pmid=25795644 |pmc=4408281 |doi=10.1212/WNL.0000000000001474 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* They may experience [[loss of consciousness]] and motor/sensory problems
*They may experience [[loss of consciousness]] and motor/sensory problems
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[EEG]]
*[[EEG]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* They response well to anti-[[seizure]] drugs
*They response well to anti-[[seizure]] drugs
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]]<br><ref name="pmid11456302">{{cite journal |vauthors=McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS |title=Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis |journal=Ann. Neurol. |volume=50 |issue=1 |pages=121–7 |date=July 2001 |pmid=11456302 |doi= |url=}}</ref><ref name="pmid3985583">{{cite journal |vauthors=Barrett L, Drayer B, Shin C |title=High-resolution computed tomography in multiple sclerosis |journal=Ann. Neurol. |volume=17 |issue=1 |pages=33–8 |date=January 1985 |pmid=3985583 |doi=10.1002/ana.410170109 |url=}}</ref><ref name="pmid10449103">{{cite journal |vauthors=Fazekas F, Barkhof F, Filippi M, Grossman RI, Li DK, McDonald WI, McFarland HF, Paty DW, Simon JH, Wolinsky JS, Miller DH |title=The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis |journal=Neurology |volume=53 |issue=3 |pages=448–56 |date=August 1999 |pmid=10449103 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]]<br><ref name="pmid11456302">{{cite journal |vauthors=McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS |title=Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis |journal=Ann. Neurol. |volume=50 |issue=1 |pages=121–7 |date=July 2001 |pmid=11456302 |doi= |url=}}</ref><ref name="pmid3985583">{{cite journal |vauthors=Barrett L, Drayer B, Shin C |title=High-resolution computed tomography in multiple sclerosis |journal=Ann. Neurol. |volume=17 |issue=1 |pages=33–8 |date=January 1985 |pmid=3985583 |doi=10.1002/ana.410170109 |url=}}</ref><ref name="pmid10449103">{{cite journal |vauthors=Fazekas F, Barkhof F, Filippi M, Grossman RI, Li DK, McDonald WI, McFarland HF, Paty DW, Simon JH, Wolinsky JS, Miller DH |title=The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis |journal=Neurology |volume=53 |issue=3 |pages=448–56 |date=August 1999 |pmid=10449103 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |
* [[Lhermitte's sign]]
*[[Lhermitte's sign]]
* [[Spasticity]]
*[[Spasticity]]
* Increased [[reflexes]]  
*Increased [[reflexes]]
* [[Internuclear ophthalmoplegia]]
*[[Internuclear ophthalmoplegia]]
* [[Optic neuritis]]
*[[Optic neuritis]]
* [[Gait disturbance]]
*[[Gait disturbance]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Elevated concentration of [[CSF]] [[oligoclonal bands]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Elevated concentration of [[CSF]] [[oligoclonal bands]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Cerebral atrophy|Brain atrophy]] and some [[contrast]] enhancing plaques on [[CT scan]]
*[[Cerebral atrophy|Brain atrophy]] and some [[contrast]] enhancing plaques on [[CT scan]]
* Cerebral plaques disseminating in space and time on [[MRI scan|MRI]]
*Cerebral plaques disseminating in space and time on [[MRI scan|MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History and physical examination]]
*[[History and Physical examination|History and physical examination]]
* [[Imaging]]
*[[Imaging]]
* [[CSF analysis]]
*[[CSF analysis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[MS]] is at least two times more common among [[women]] than [[men]]
*[[MS]] is at least two times more common among [[women]] than [[men]]
* The onset of [[symptoms]] is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty
*The onset of [[symptoms]] is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain tumor|Brain tumors]]<br><ref name="DunniwayWelling2016">{{cite journal|last1=Dunniway|first1=Heidi M.|last2=Welling|first2=D. Bradley|title=Intracranial Tumors Mimicking Benign Paroxysmal Positional Vertigo|journal=Otolaryngology–Head and Neck Surgery|volume=118|issue=4|year=2016|pages=429–436|issn=0194-5998|doi=10.1177/019459989811800401}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain tumor|Brain tumors]]<br><ref name="DunniwayWelling2016">{{cite journal|last1=Dunniway|first1=Heidi M.|last2=Welling|first2=D. Bradley|title=Intracranial Tumors Mimicking Benign Paroxysmal Positional Vertigo|journal=Otolaryngology–Head and Neck Surgery|volume=118|issue=4|year=2016|pages=429–436|issn=0194-5998|doi=10.1177/019459989811800401}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Papilledema]]
*[[Papilledema]]
* [[Focal neurological deficits]]
*[[Focal neurological deficits]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Cerebral spinal fluid ([[CSF]]) may show cancerous cells
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Cerebral spinal fluid ([[CSF]]) may show cancerous cells
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* On [[CT scan]] most of the [[brain tumors]] appears as a hypodense mass lesions
*On [[CT scan]] most of the [[brain tumors]] appears as a hypodense mass lesions
* On [[MRI scan|MRI]] most of the [[brain tumors]] appears as a hypointense or isointense on T1-weighted scans, or hyperintense on T2-weighted [[MRI contrast agent|MRI]].
*On [[MRI scan|MRI]] most of the [[brain tumors]] appears as a hypointense or isointense on T1-weighted scans, or hyperintense on T2-weighted [[MRI contrast agent|MRI]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
*[[Imaging]]


* [[Biopsy forceps|Biopsy]]
*[[Biopsy forceps|Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patieny may experience  [[headache]], [[seizures]], [[Visual disturbance|visual changes]] and changes in [[personality]], [[mood]] and [[concentration]]
*Patieny may experience  [[headache]], [[seizures]], [[Visual disturbance|visual changes]] and changes in [[personality]], [[mood]] and [[concentration]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cerebellar infarction]]/hemorrhage
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cerebellar infarction]]/hemorrhage
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* [[Limb]] [[ataxia]]
*[[Limb]] [[ataxia]]
* [[Gait abnormality|Gait disturbance]]
*[[Gait abnormality|Gait disturbance]]
* [[Dysarthria]]
*[[Dysarthria]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Based on the time interval between [[stroke]] and [[imaging]] we may have different presentations
*Based on the time interval between [[stroke]] and [[imaging]] we may have different presentations
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Posterior inferior cerebellar artery]] is the most common artery that causes [[vertigo]]
*[[Posterior inferior cerebellar artery]] is the most common artery that causes [[vertigo]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Brain stem ischemia
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Brain stem ischemia
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Contralateral body [[Muscle weakness|weakness]]
*Contralateral body [[Muscle weakness|weakness]]
* [[Visual field]] deficits
*[[Visual field]] deficits
* [[Oculomotor nerve|Oculomotor]] abnormalities
*[[Oculomotor nerve|Oculomotor]] abnormalities
* [[Bulbar]] findings
*[[Bulbar]] findings
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Based on the time interval between [[stroke]] and [[imaging]] we may have different presentations
*Based on the time interval between [[stroke]] and [[imaging]] we may have different presentations
* For more information [[Ischemic stroke CT|click here]]
*For more information [[Ischemic stroke CT|click here]]


| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* It may be associated with [[subclavian steal syndrome]]
*It may be associated with [[subclavian steal syndrome]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chiari malformation]]<br><ref name="pmid15034729">{{cite journal |vauthors=Caldarelli M, Di Rocco C |title=Diagnosis of Chiari I malformation and related syringomyelia: radiological and neurophysiological studies |journal=Childs Nerv Syst |volume=20 |issue=5 |pages=332–5 |date=May 2004 |pmid=15034729 |doi=10.1007/s00381-003-0880-4 |url=}}</ref><ref name="pmid18809020">{{cite journal |vauthors=Sarnat HB |title=Disorders of segmentation of the neural tube: Chiari malformations |journal=Handb Clin Neurol |volume=87 |issue= |pages=89–103 |date=2008 |pmid=18809020 |doi=10.1016/S0072-9752(07)87006-0 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chiari malformation]]<br><ref name="pmid15034729">{{cite journal |vauthors=Caldarelli M, Di Rocco C |title=Diagnosis of Chiari I malformation and related syringomyelia: radiological and neurophysiological studies |journal=Childs Nerv Syst |volume=20 |issue=5 |pages=332–5 |date=May 2004 |pmid=15034729 |doi=10.1007/s00381-003-0880-4 |url=}}</ref><ref name="pmid18809020">{{cite journal |vauthors=Sarnat HB |title=Disorders of segmentation of the neural tube: Chiari malformations |journal=Handb Clin Neurol |volume=87 |issue= |pages=89–103 |date=2008 |pmid=18809020 |doi=10.1016/S0072-9752(07)87006-0 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |
* [[Tachycardia]]  
*[[Tachycardia]]
* [[Pupillary dilatation]]
*[[Pupillary dilatation]]
* Impaired [[gag reflex]]
*Impaired [[gag reflex]]
* Impaired [[coordination]]
*Impaired [[coordination]]
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see [[hydrocephalus]], herniated [[cerebellar tonsils]], and a flattened [[spinal cord]]
*In [[CT scan]] we may see [[hydrocephalus]], herniated [[cerebellar tonsils]], and a flattened [[spinal cord]]
* In [[MRI]] we may see [[Cerebellar tonsil|cerebellar tonsillar]] [[herniation]], wedge shaped tonsils, syringohydromyelia, small [[posterior fossa]], obstructive [[hydrocephalus]], and [[brainstem]] anomalies
*In [[MRI]] we may see [[Cerebellar tonsil|cerebellar tonsillar]] [[herniation]], wedge shaped tonsils, syringohydromyelia, small [[posterior fossa]], obstructive [[hydrocephalus]], and [[brainstem]] anomalies
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patient may experience ringing in the [[Ear|ears]]
*Patient may experience ringing in the [[Ear|ears]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parkinson's disease|Parkinson]]<br><ref name="van Wensenvan Leeuwen2013">{{cite journal|last1=van Wensen|first1=E.|last2=van Leeuwen|first2=R.B.|last3=van der Zaag-Loonen|first3=H.J.|last4=Masius-Olthof|first4=S.|last5=Bloem|first5=B.R.|title=Benign paroxysmal positional vertigo in Parkinson's disease|journal=Parkinsonism & Related Disorders|volume=19|issue=12|year=2013|pages=1110–1112|issn=13538020|doi=10.1016/j.parkreldis.2013.07.024}}</ref><ref name="pmid3990948">{{cite journal |vauthors=Steiner I, Gomori JM, Melamed E |title=Features of brain atrophy in Parkinson's disease. A CT scan study |journal=Neuroradiology |volume=27 |issue=2 |pages=158–60 |date=1985 |pmid=3990948 |doi= |url=}}</ref><ref name="pmid15981079">{{cite journal |vauthors=Kosta P, Argyropoulou MI, Markoula S, Konitsiotis S |title=MRI evaluation of the basal ganglia size and iron content in patients with Parkinson's disease |journal=J. Neurol. |volume=253 |issue=1 |pages=26–32 |date=January 2006 |pmid=15981079 |doi=10.1007/s00415-005-0914-9 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parkinson's disease|Parkinson]]<br><ref name="van Wensenvan Leeuwen2013">{{cite journal|last1=van Wensen|first1=E.|last2=van Leeuwen|first2=R.B.|last3=van der Zaag-Loonen|first3=H.J.|last4=Masius-Olthof|first4=S.|last5=Bloem|first5=B.R.|title=Benign paroxysmal positional vertigo in Parkinson's disease|journal=Parkinsonism & Related Disorders|volume=19|issue=12|year=2013|pages=1110–1112|issn=13538020|doi=10.1016/j.parkreldis.2013.07.024}}</ref><ref name="pmid3990948">{{cite journal |vauthors=Steiner I, Gomori JM, Melamed E |title=Features of brain atrophy in Parkinson's disease. A CT scan study |journal=Neuroradiology |volume=27 |issue=2 |pages=158–60 |date=1985 |pmid=3990948 |doi= |url=}}</ref><ref name="pmid15981079">{{cite journal |vauthors=Kosta P, Argyropoulou MI, Markoula S, Konitsiotis S |title=MRI evaluation of the basal ganglia size and iron content in patients with Parkinson's disease |journal=J. Neurol. |volume=253 |issue=1 |pages=26–32 |date=January 2006 |pmid=15981079 |doi=10.1007/s00415-005-0914-9 |url=}}</ref>
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* [[Hypomimia]]
*[[Hypomimia]]
* Cogwheel rigidity
*Cogwheel rigidity
* Resting [[tremor]]
*Resting [[tremor]]


* [[Gait Abnormalities|Gait problems]]
*[[Gait Abnormalities|Gait problems]]
* [[Bradykinesia]]
*[[Bradykinesia]]
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* On [[brain]] [[CT scan]], [[Parkinson's disease|Parkinson disease]] is characterized by cortical and subcortical [[atrophy]]
*On [[brain]] [[CT scan]], [[Parkinson's disease|Parkinson disease]] is characterized by cortical and subcortical [[atrophy]]
* [[MRI]] findings in [[Parkinson disease]] are reduction in T2 relaxation time and reduced [[iron]] content in [[putamen]] and [[Globus pallidus|GPe]]
*[[MRI]] findings in [[Parkinson disease]] are reduction in T2 relaxation time and reduced [[iron]] content in [[putamen]] and [[Globus pallidus|GPe]]
| style="background: #F5F5F5; padding: 5px;" |
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* [[History and Physical examination|History and physical examination]]
*[[History and Physical examination|History and physical examination]]
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* Patients may present with slowness of movement ([[bradykinesia]]), shaking hands while they are at rest (resting [[tremor]]) and [[Muscle rigidity|muscle stiffness (rigidity)]].
*Patients may present with slowness of movement ([[bradykinesia]]), shaking hands while they are at rest (resting [[tremor]]) and [[Muscle rigidity|muscle stiffness (rigidity)]].
|}
|}
'''ABBREVIATIONS'''
'''ABBREVIATIONS'''

Latest revision as of 20:08, 20 January 2021

Vertigo Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Many disease cause vertigo as a symptom, following diseases must be investigated as a differential diagnosis for vertigo symptom: Vestibular neuritis, HSV oticus, Meniere disease, labyrinrhine concussion, perilymphatic fistula, semicircular canal dehiscence syndrome, vestibular paroxysmia, Cogan syndrome, vestibular schwannoma, otitis media, aminoglycoside toxicity, recurrent vestibulopathy, vestibular migraine, epileptic vertigo, multiple sclerosis, brain tumors, cerebellar infarction/hemorrhage, brain stem ischemia, chiari malformation, and Parkinson.

Differentiating Vertigo from Other Diseases

Differentiating vertigo from other diseases

Many disease cause vertigo as a symptom, following diseases must be investigated as a differential diagnosis for vertigo symptom: Vestibular neuritis, HSV oticus, Meniere disease, labyrinrhine concussion, perilymphatic fistula, semicircular canal dehiscence syndrome, vestibular paroxysmia, Cogan syndrome, vestibular schwannoma, otitis media, aminoglycoside toxicity, recurrent vestibulopathy, vestibular migraine, epileptic vertigo, multiple sclerosis, brain tumors, cerebellar infarction/hemorrhage, brain stem ischemia, chiari malformation, and Parkinson.[1]

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Acute onset Recurrency Nystagmus Hearing problems
Peripheral
BPPV
[2][3][4]
+ + +/−
Vestibular neuritis
[5]
+ +/− + /−

(unilateral)

  • + Head thrust test
HSV oticus
[6][7][8][9]
+ +/− +/− + VZV antibody titres
Meniere disease
[10][11]
+/− + +/− + (Progressive)
Labyrinthine concussion
[12][13]
+ +
Perilymphatic fistula
[14][15][16]
+/− + +
  • CT scan may show fluid around the round window recess
Semicircular canal

dehiscence syndrome
[17][18]

+/− + +

(air-bone gaps on audiometry)

Vestibular paroxysmia
[19][20][21]
+ + +/−

(Induced by hyperventilation)

Cogan syndrome
[22][23][24]
+ +/− + Increased ESR and cryoglobulins
  • In CT scan we may see calcification or soft tissue attenuation obliterating the intralabyrinthine fluid spaces
Vestibular schwannoma
[25][26]
+ +/− +
Otitis media
[27][28]
+ +/− Increased acute phase reactants
Aminoglycoside toxicity
[29]
+ +
Recurrent vestibulopathy
[30][31]
+
  • It may happen infrequently, every one to two years
  • It may be associated with nausea and vomiting
  • It may overlap with vestibular migraine
Central
Vestibular migrain
[32][33]
+ +/− +/−
  • ICHD-3 criteria
Epileptic vertigo
[34]
+ +/−
  • They response well to anti-seizure drugs
Multiple sclerosis
[35][36][37]
+ +/− Elevated concentration of CSF oligoclonal bands
  • MS is at least two times more common among women than men
  • The onset of symptoms is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty
Brain tumors
[38]
+/− + + + Cerebral spinal fluid (CSF) may show cancerous cells
  • On CT scan most of the brain tumors appears as a hypodense mass lesions
  • On MRI most of the brain tumors appears as a hypointense or isointense on T1-weighted scans, or hyperintense on T2-weighted MRI.
Cerebellar infarction/hemorrhage + ++/−
  • Based on the time interval between stroke and imaging we may have different presentations
Brain stem ischemia + +/−
  • Based on the time interval between stroke and imaging we may have different presentations
  • For more information click here
Chiari malformation
[39][40]
+ +
  • Patient may experience ringing in the ears
Parkinson
[41][42][43]
+

ABBREVIATIONS

VZV= Varicella zoster virus, MRI= Magnetic resonance imaging, ESR= Erythrocyte sedimentation rate, EEG= Electroencephalogram, CSF= Cerebrospinal fluid, GPe= Globus pallidus externa, ICHD= International Classification of Headache Disorders

References

  1. Labuguen RH (2006). "Initial evaluation of vertigo". Am Fam Physician. 73 (2): 244–51. PMID 16445269.
  2. Lee SH, Kim JS (June 2010). "Benign paroxysmal positional vertigo". J Clin Neurol. 6 (2): 51–63. doi:10.3988/jcn.2010.6.2.51. PMC 2895225. PMID 20607044.
  3. Chang MB, Bath AP, Rutka JA (October 2001). "Are all atypical positional nystagmus patterns reflective of central pathology?". J Otolaryngol. 30 (5): 280–2. PMID 11771020.
  4. Dorresteijn PM, Ipenburg NA, Murphy KJ, Smit M, van Vulpen JK, Wegner I, Stegeman I, Grolman W (June 2014). "Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo". Otolaryngol Head Neck Surg. 150 (6): 919–24. doi:10.1177/0194599814527233. PMID 24642523.
  5. Mandalà M, Nuti D, Broman AT, Zee DS (February 2008). "Effectiveness of careful bedside examination in assessment, diagnosis, and prognosis of vestibular neuritis". Arch. Otolaryngol. Head Neck Surg. 134 (2): 164–9. doi:10.1001/archoto.2007.35. PMID 18283159.
  6. Wackym, Phillip A. (1997). "Molecular Temporal Bone Pathology: II. Ramsay Hunt Syndrome (Herpes Zoster Oticus)". The Laryngoscope. 107 (9): 1165–1175. doi:10.1097/00005537-199709000-00003. ISSN 0023-852X.
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