Vertigo differential diagnosis: Difference between revisions

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==Overview==
==Overview==
*Vertigo is a type of dizziness therefore it must be differentiated from other diseases that causes imbalance, dizziness, and lightheadedness.
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 ===
*[[Acute]] anemia
 
*[[Anxiety]] disorders
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>
*[[Benign Paroxysmal Positional Vertigo]]
{|
*Brain [[tumors]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
*Chronic [[anemia]]
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
*[[Giant cell arteritis]]
| colspan="5" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
*Herpes zoster oticus ([[Ramsay-Hunt Syndrome]]
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
*[[Labyrinthitis]]
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
*[[Mastoiditis]]
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
*[[Ménière disease]]
|-
*[[Meningitis]]
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
*[[Migraine]] [[headache]]
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
*[[Multiple sclerosis]]
|-
*Stroke
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
*[[Vertebrobasilar atherothrombotic disease]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
*[[Vestibular neuronitis]]
|-
*[[Wernicke encephalopathy]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acute onset
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Recurrency
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nystagmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hearing problems
|-
| colspan="10" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |'''Peripheral'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign paroxysmal positional vertigo|BPPV]]<br><ref name="pmid20607044">{{cite journal |vauthors=Lee SH, Kim JS |title=Benign paroxysmal positional vertigo |journal=J Clin Neurol |volume=6 |issue=2 |pages=51–63 |date=June 2010 |pmid=20607044 |pmc=2895225 |doi=10.3988/jcn.2010.6.2.51 |url=}}</ref><ref name="pmid11771020">{{cite journal |vauthors=Chang MB, Bath AP, Rutka JA |title=Are all atypical positional nystagmus patterns reflective of central pathology? |journal=J Otolaryngol |volume=30 |issue=5 |pages=280–2 |date=October 2001 |pmid=11771020 |doi= |url=}}</ref><ref name="pmid24642523">{{cite journal |vauthors=Dorresteijn PM, Ipenburg NA, Murphy KJ, Smit M, van Vulpen JK, Wegner I, Stegeman I, Grolman W |title=Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo |journal=Otolaryngol Head Neck Surg |volume=150 |issue=6 |pages=919–24 |date=June 2014 |pmid=24642523 |doi=10.1177/0194599814527233 |url=}}</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;" |
*+ [[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;" |
*[[Dix-Hallpike test|Dix-Hallpike maneuver]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + /−
(unilateral)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*+ Head thrust test
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*Taste loss in the front two-thirds of the [[tongue]]
*[[Acute facial nerve paralysis]]
*[[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;" |
*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;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" | + (Progressive)
| style="background: #F5F5F5; padding: 5px;" |
*[[Sensorineural hearing loss]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*In [[CT scan]] we may see small or invisible [[vestibular aqueduct]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]/ Rulling out other diagnoses
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*[[high frequency hearing loss]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*We may see other evidences of [[head trauma]] or [[temporal bone]] [[fracture]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*It happens following blunt [[head trauma]]
*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: #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;" |
*[[Tullio phenomenon]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*[[CT scan]] may show fluid around the round window recess
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]/[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*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
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Semicircular canal
dehiscence syndrome<br><ref name="pmid15655395">{{cite journal |vauthors=Lempert T, von Brevern M |title=Episodic vertigo |journal=Curr. Opin. Neurol. |volume=18 |issue=1 |pages=5–9 |date=February 2005 |pmid=15655395 |doi= |url=}}</ref><ref name="pmid10680810">{{cite journal |vauthors=Watson SR, Halmagyi GM, Colebatch JG |title=Vestibular hypersensitivity to sound (Tullio phenomenon): structural and functional assessment |journal=Neurology |volume=54 |issue=3 |pages=722–8 |date=February 2000 |pmid=10680810 |doi= |url=}}</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;" | +
 
(air-bone gaps on audiometry)
| style="background: #F5F5F5; padding: 5px;" |
*[[Tullio phenomenon]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*[[CT scan]] may show defect in the arcuate eminence of the [[superior semicircular canal]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]/[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
 
(Induced by [[hyperventilation]])
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Impaired [[Caloric reflex test|caloric testing]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*We may see evidence of [[vestibulocochlear nerve]] compression on [[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]/Imaging
| style="background: #F5F5F5; padding: 5px;" |
*It may be provoked by head turn or other action
*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: #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;" |
*[[Interstitial keratitis]]
*[[Oscillopsia]]
*Absent [[vestibular function]] on [[Caloric reflex test|caloric test]]
*[[Systemic vasculitis]] ([[Aortitis]])
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Increased [[ESR]] and  [[cryoglobulins]]
| style="background: #F5F5F5; padding: 5px;" |
*In [[CT scan]] we may see [[calcification]] or soft tissue attenuation obliterating the intralabyrinthine fluid spaces
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*It may cause [[Ménière's disease|Ménière]]-like attacks
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vestibular schwannoma]]<br><ref>{{Cite journal
| author = [[Robert W. Foley]], [[Shahram Shirazi]], [[Robert M. Maweni]], [[Kay Walsh]], [[Rory McConn Walsh]], [[Mohsen Javadpour]] & [[Daniel Rawluk]]
| title = Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis
| journal = [[Cureus]]
| volume = 9
| issue = 11
| pages = e1846
| year = 2017
| month = November
| doi = 10.7759/cureus.1846
| pmid = 29348989
}}</ref><ref>{{Cite journal
| author = [[E. P. Lin]] & [[B. T. Crane]]
| title = The Management and Imaging of Vestibular Schwannomas
| journal = [[AJNR. American journal of neuroradiology]]
| volume = 38
| issue = 11
| pages = 2034–2043
| year = 2017
| month = November
| doi = 10.3174/ajnr.A5213
| pmid = 28546250
}}</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;" |
*[[Sensorineural hearing loss]]
*+ [[Rinne test]]
*Lateralization of [[Weber test]] to the normal [[ear]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*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]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*[[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: #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;" |
*Fever
*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;" |
*Opacification of the [[middle ear]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*[[Oscillopsia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*May be associated with [[nausea]], [[vomiting]], and [[ataxia]]
*It may be irreversible
*[[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: #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;" |
*[[History and Physical examination|History/ Physical exam]]
| style="background: #F5F5F5; padding: 5px;" |
*The underlying [[pathophysiology]] is unknown
 
*It may happen infrequently, every one to two years
*It may be associated with [[nausea]] and [[vomiting]]
*It may overlap with vestibular [[migraine]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="10" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Central
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Vestibular migrain<br><ref name="pmid14979299">{{cite journal |vauthors= |title=The International Classification of Headache Disorders: 2nd edition |journal=Cephalalgia |volume=24 Suppl 1 |issue= |pages=9–160 |date=2004 |pmid=14979299 |doi= |url=}}</ref><ref name="pmid22714135">{{cite journal |vauthors=Absinta M, Rocca MA, Colombo B, Copetti M, De Feo D, Falini A, Comi G, Filippi M |title=Patients with migraine do not have MRI-visible cortical lesions |journal=J. Neurol. |volume=259 |issue=12 |pages=2695–8 |date=December 2012 |pmid=22714135 |doi=10.1007/s00415-012-6571-x |url=}}</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;" |
*History of [[migraine headaches]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*They may have [[White matter|white-matter]] hyperintensities (WMHs) on [[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
*ICHD-3 criteria
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*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;" |
*[[EEG]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*[[Lhermitte's sign]]
*[[Spasticity]]
*Increased [[reflexes]]
*[[Internuclear ophthalmoplegia]]
*[[Optic neuritis]]
*[[Gait disturbance]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Elevated concentration of [[CSF]] [[oligoclonal bands]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Cerebral atrophy|Brain atrophy]] and some [[contrast]] enhancing plaques on [[CT scan]]
*Cerebral plaques disseminating in space and time on [[MRI scan|MRI]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History and physical examination]]
*[[Imaging]]
*[[CSF analysis]]
| style="background: #F5F5F5; padding: 5px;" |
*[[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
|-
| 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: #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;" |
*[[Papilledema]]
*[[Focal neurological deficits]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Cerebral spinal fluid ([[CSF]]) may show cancerous cells
| style="background: #F5F5F5; padding: 5px;" |
*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]].
| style="background: #F5F5F5; padding: 5px;" |
*[[Imaging]]
 
*[[Biopsy forceps|Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*[[Limb]] [[ataxia]]
*[[Gait abnormality|Gait disturbance]]
*[[Dysarthria]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Based on the time interval between [[stroke]] and [[imaging]] we may have different presentations
| style="background: #F5F5F5; padding: 5px;" |
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*[[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: #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;" |
*Contralateral body [[Muscle weakness|weakness]]
*[[Visual field]] deficits
*[[Oculomotor nerve|Oculomotor]] abnormalities
*[[Bulbar]] findings
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*Based on the time interval between [[stroke]] and [[imaging]] we may have different presentations
*For more information [[Ischemic stroke CT|click here]]
 
| style="background: #F5F5F5; padding: 5px;" |
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*[[Tachycardia]]
*[[Pupillary dilatation]]
*Impaired [[gag reflex]]
*Impaired [[coordination]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*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
| style="background: #F5F5F5; padding: 5px;" |
*[[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*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: #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;" |
*[[Hypomimia]]
*Cogwheel rigidity
*Resting [[tremor]]
 
*[[Gait Abnormalities|Gait problems]]
*[[Bradykinesia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
*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]]
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History and physical examination]]
| style="background: #F5F5F5; padding: 5px;" |
*Patients may present with slowness of movement ([[bradykinesia]]), shaking hands while they are at rest (resting [[tremor]]) and [[Muscle rigidity|muscle stiffness (rigidity)]].
|}
'''ABBREVIATIONS'''
 
[[VZV]]= [[Varicella zoster virus]], [[MRI]]= [[Magnetic resonance imaging]], [[ESR]]= [[Erythrocyte sedimentation rate]], [[EEG]]= [[Electroencephalogram]], [[CSF]]= [[Cerebrospinal fluid]], GPe= [[Globus pallidus|Globus pallidus externa]], ICHD=  International Classification of Headache Disorders


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]

Latest revision as of 20:08, 20 January 2021

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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.
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  25. ↑ Robert W. Foley, Shahram Shirazi, Robert M. Maweni, Kay Walsh, Rory McConn Walsh, Mohsen Javadpour & Daniel Rawluk (2017). "Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis". Cureus. 9 (11): e1846. doi:10.7759/cureus.1846. PMID 29348989. Unknown parameter |month= ignored (help)
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  43. ↑ Kosta P, Argyropoulou MI, Markoula S, Konitsiotis S (January 2006). "MRI evaluation of the basal ganglia size and iron content in patients with Parkinson's disease". J. Neurol. 253 (1): 26–32. doi:10.1007/s00415-005-0914-9. PMID 15981079.

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