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==Overview==
==Overview==
[[Vertigo]] can be described as subjection [[sensation]] of movement such as spinning, turning or whirling of patients or respective surroundings. [[Vertigo]] is a symptom not a diagnosis. It results from dysfunction either in the [[Vestibular system|vestibular]] or central nervous system ; thus can be classified as peripheral or central vertigo respectively. Some conditions can present with subjective feeling of dizziness without vertigo hence named as [[Pseudovertigo|pseudo-vertigo]]. Most children or adolescents have secondary vertigo as a result of various conditions such as otitis media, benign paroxysmal vertigo, head trauma or any CNS infection. Successful management of vertigo usually consists of identifying the root cause and specifically targeting the underlying condition.
[[Vertigo]] can be described as subjection [[sensation]] of movement such as spinning, turning, or whirling of patients or respective surroundings. [[Vertigo]] is a symptom, not a diagnosis. It results from dysfunction either in the [[Vestibular system|vestibular]] or central nervous system; thus can be classified as peripheral or central vertigo respectively. Some conditions can present with a subjective feeling of dizziness without vertigo hence named as [[Pseudovertigo|pseudo-vertigo]]. Most children or adolescents have secondary vertigo as a result of various conditions such as otitis media, benign paroxysmal vertigo, head trauma, or any CNS infection. Successful management of vertigo usually consists of identifying the root cause and specifically targeting the underlying condition.


==Causes==
==Causes==
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==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
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==Do's==
==Do's==
* The content in this section is in bullet points.


==Don'ts==
==Don'ts==
* The content in this section is in bullet points.
==References==
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Revision as of 18:52, 30 July 2020

Vertigo resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Overview

Vertigo can be described as subjection sensation of movement such as spinning, turning, or whirling of patients or respective surroundings. Vertigo is a symptom, not a diagnosis. It results from dysfunction either in the vestibular or central nervous system; thus can be classified as peripheral or central vertigo respectively. Some conditions can present with a subjective feeling of dizziness without vertigo hence named as pseudo-vertigo. Most children or adolescents have secondary vertigo as a result of various conditions such as otitis media, benign paroxysmal vertigo, head trauma, or any CNS infection. Successful management of vertigo usually consists of identifying the root cause and specifically targeting the underlying condition.

Causes

Life-Threatening Causes Common Misc.
  • Head trauma (labyrinthine concussion, whiplash syndrome, basilar artery migraine)
  • CNS infection
  • Intake of specific Poison
  • Drug Adverse Effect
  • Stroke
  • Brain tumor
  • Congenital ear abnormalities (Mondini's malformation, enlarged vestibular aqueduct)
  • Binocular vision abnormalities
  • Benign paroxysmal vertigo of childhood
  • Vestibular neuritis
  • Migraine
  • Somatoform vertigo  
  • Motion sickness
  • Otitis media complicated by labyrinthitis
  • Mastoiditis
  • Meniere disease
  • Middle ear trauma
  • Multiple sclerosis
  • Perilymph fistula
  • Ramsay Hunt syndrome
  • Seizure

FIRE: Focused Initial Rapid Evaluation

 
 
 
 
 
Identify cardinal findings that increase the pretest probability of vertigo (at least 2 of the following)
❑ Physical sensation of spinning or moving
❑ Nystagmus
❑ Nausea with or without vomiting
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History of Head Trauma
 
 
 
Pseudovertigo
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Findings of Abnormal CT-Scan/MRI
 
 
 
Altered level of Consciousness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
NO
 
YES
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fracture of Temoral Bone,enlarged vestibular aqueduct
 
Post-concussion syndrome, Post traumatic migraine
 
If History of fever , Consider CNS infections such as meningitis and encephalitis If abnormal CT-Scan Brain or MRI, consider Migraine, Drug Overdosingm or Post-ictal state
 
Perform Otoscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive Otoscopic Findings

The differential should Include ❑ Abnormal Canal

   •Cerumen Impaction
    • Foreign Body
   • Ramsy Hunt Syndrome

❑ Middle ear Effusion ❑ Cholesteatoma

❑Perilymphatic fistula
 
 
 
History of travel  ?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If Yes Consider Motion Sickness
 
 
 
Abnormal vestibular testing?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abnormal CT-Scan/MRI?
 
 
 
 
Decreased Hearing?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
NO
 
YES
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CNS tumor
 
❑ BPPV

❑Migraine ❑Seizure

❑Perilymphatic fistula
 
❑BPPV Vestribular

❑Neutritis

❑Stroke
 
❑Drug Overdose ❑Meniere Disease


Complete Diagnostic Approach

 
 
 
 
 
Sings of Vertigo in Children
❑Frightening-Clutching caretakers
❑Clumsiness
❑ Periodic Nausea/vomiting
❑ Delayed Motor Function
❑ Loss of Postural Control
❑ Difficulty in ambulation
❑ The infant may lie face down against the side of the crib with eyes closed, not wanting to be moved
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
General History
❑History of Prenatal/ Perinatal infection
❑Use of Otoxic Medications
❑ Congential Syndromes
❑Craniofacial anomalies
❑ Loss of Postural Control
❑Family history of hearing loss/vertigo, migraine or demyelinating disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Specific History
❑Episodic vs Continuous
❑Time of Onset Acute/slow
❑Triggered vs spontaneous
❑Associated with hearing loss or without hearing loss
❑ Loss of Postural Control
❑ Neurological deficits
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical Examination

•  Otologic exam •  Neurological exam •  Check visual acuity

•  Static and dynamic imbalance of vestibular function time of Onset Acute/slow
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gait & Gross Motor Testing

•  Vestibulospinal testing

   –  Fukuda
   –  Romberg test
   –  Tandem gait

•  Age-appropriate gross motor

(Bruininks- Oseretsky test 4-21yrs)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Workup

•  Audiology evaluation •  Eye examination •  Vestibular function test •  EEG •  Hematological workup (CBC, electrolytes, glucose, thyroid tests) •  Imaging indication –  Focal neurological symptoms or findings –  Worsening symptoms – Prolonged LOC (> 1 min)

–  Failure of symptoms to improve
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vestibular Function Testing

•  ENG battery •  Rotation testing •  Platform posturography •  Dix-Hallpike - PSSC •  Gaze testing •  Caloric ENG – LSSC –  >30% difference between side indicates

a unilateral peripheral lesionion Testing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Imaging

  CT of Temporal Bone –  Further evaluate craniofacial syndromes & PLF –  Defects in bony labyrinth, cholesteatoma –  Suspect tumor or previous trauma •  MRI with gadolinium –  Children with CNS findings –  Suspect schwannomas and other tumors

–  Granulomatous disorders
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References


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