Central Vertigo

The feeling that you get when you spin around for a long time, or when you just get off an amusement park ride, is well known to Vertigo patients. Vertigo is characterized by spinning sensations, dizziness, nausea, vomiting, & motion sickness. Vertigo symptoms can also sometimes include migraine headaches. It’s also important to know that Vertigo isn’t a condition in itself, rather a symptom of some underlying condition. There are two distinct types of Vertigo is Central Vertigo & Peripheral Vertigo:

  • Central Vertigo,
  • Peripheral Vertigo

Peripheral Vertigo:

Peripheral Vertigo is the most common type of Vertigo. It is caused by problems in the inner ear. The inner ear houses the body’s vestibular system, which helps maintain the body’s balance. When disturbances occur inside the inner ear, either in the form of an injury, an infection, or the displacement of calcium crystals from their original position, it causes issues with the functioning of the vestibular system.

Some of the common causes of Peripheral Vertigo include:

  • Benign Paroxysmal Positional Vertigo(BPPV),
  • Vestibular Neuronitis,
  • Meniere’s Disease,
  • Labyrinthitis,
  • Perilymph Fistula,
  • Superior Semicircular canal dehiscence syndrome(SSCD)

Sometimes, peripheral vertigo can also be caused by certain head injuries, inner ear infections, or recent head trauma. Vertigo treatment for this type of Vertigo involves canalith repositioning maneuvers like the Epley Maneuver, the Brandt-Daroff exercises, the Semont-Foster maneuver & more. Patients may also be recommended to take certain Vertigo medicines that aid in Vertigo treatment.  In some cases, surgery may be the last resort for patients looking for immediate relief from their Vertigo symptoms.

Central Vertigo:

Vertigo is caused by problems with the brain, & the way it receives & processed information regarding the body’s balance sensors.

Central Vertigo causes include:

  • Head injuries
  • Illness or infection
  • Multiple sclerosis
  • Migraines
  • Brain tumors
  • Strokes
  • Transient ischemic attacks, which are basically “mini” strokes that last for a short time and don’t cause permanent damage

One consistent fact in the Central Vertigo vs Peripheral Vertigo debate is the fact that while Peripheral Vertigo symptoms occur spontaneously & last for short bursts of time, central vertigo symptoms occur suddenly without warning & last for longer periods of time. Central vertigo attacks are also generally more intense than those of Peripheral Vertigo, & patients might need help in standing or walking.

Also, while jerky & unusual eye movement (nystagmus) is common in both types of vertigo, in Central vertigo these eye movements occur more frequently, last longer, & don’t stop even while focusing on a certain fixed target.  Another difference that crops up between the Central Vertigo Vs Peripheral Vertigo debate is that while hearing loss & trouble with hearing is a common feature of the latter, it is not one of the Central vertigo signs.

Although Central Vertigo symptoms may include headaches, weakness, & trouble swallowing.

Central Vertigo Treatment:

Central Vertigo treatment includes finding out the exact cause of the Vertigo symptoms, & treating it. For instance, if migraines are the cause of Central Vertigo symptoms, then your Central Vertigo treatment plan might include migraine treatment remedies like certain medications, pain relief, & stress-reducing activities. If the Central Vertigo signs are due to conditions such as Multiple Sclerosis & some tumors, vertigo treatment may consist of treating & managing the symptoms like medicines for nausea & for reducing the sensation of movement.

Differentiating Central Vertigo Vs Peripheral Vertigo:

When a patient presents with the symptoms of Vertigo, it is of extreme importance to clearly differentiate between the two. While most patients experiencing Vertigo symptoms will have a case of Peripheral Vertigo, some might also have vertigo signs. The identification & isolation of Central Vertigo cases is extremely important, as central Vertigo causes relate to brainstem ischemia or infractions. Diagnosis can be done easily by taking a brief history of the Vertigo symptoms.

This includes the time since the symptoms started, how long they last, the intensity of each Vertigo episode, & related symptoms. Doctors must check for any hearing impairments, any inner ear issue, fever, viral infections, jerky & unusual eye movements, & any other signs that appear out of the ordinary. These include any rashes, hives, or the appearance of any allergies on the skin, or any other difficulty the patient is experiencing. If other conditions are present, adequate tests must be ordered to find out the exact cause of those.

The vitals and any skin rashes might suggest the herpes zoster of the external ear, hence adequate physical exams must be performed to look for any problems with this area. The presence of a neck bruit may indicate some underlying carotid or vertebral stenosis issue.
Along with external examinations, cardiac exams are also very important to rule out an arrhythmia, especially atrial fibrillation or valvular heart disease which may cause issues later on.

To rule out Benign Paroxysmal Positional Vertigo (BPPV), the Dix-Hallpike maneuver needs to be performed. Besides, doctors should also perform a detailed and quick neurological exam to look for Horner syndrome and other brainstem signs. Finally, the “HINTS” test needs to be performed on every patient suspected to be experiencing central vertigo. However, it’s important to remember that the test is only valid when the patient is still suffering from a case of ongoing, continuous vertigo at the time of the exam.

The HINTS stands for head impulse test, nystagmus, and skew deviation. It is the best bedside test to differentiate central Vs peripheral vertigo. To perform the head impulse (head thrust) test, the patient is asked to look at the examiner’s nose. The examiner then quickly, albeit gently, thrusts the patient’s head about 30 degrees to one side and looks for any resultant catch-up saccade. The test is said to be positive when there is a catch-up saccade on one side. The side that results in a catch-up saccade is the side with peripheral vestibular dysfunction.

It is also important to note that a positive head impulse test indicates a peripheral cause for vertigo, which is usually not a serious prognosis. The nystagmus that occurs in peripheral vertigo is always unidirectional along with a rotary element, regardless of the direction of the patient’s gaze.

On the other hand, the nystagmus that occurs in central vertigo is more often present with direction-changing nystagmus. The nystagmus will be right beating when the patient’s gaze is fixed to the right and will change to a left beating when the patient’s gaze is to the left.

Any vertical nystagmus, however, indicates a central cause for vertigo. The last part of the HINTS test is a skew deviation. The presence of a skew deviation (where one eye moves higher than another eye) makes for a positive central Vertigo diagnosis. This skew deviation can be assessed by alternately covering the patient’s eyes and looking for the appearance of a vertical corrective saccade on the affected side.

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