Thank you to Dr. Nandita Sriram for an excellent review of vertigo!
Learning Points:
— Taking a good history is pertinent in distinguishing between dizziness vs true vertigo
— Differentiate between peripheral vs central etiologies of vertigo
- Peripheral causes: BPPV, vestibular neuronitis, meniere disease, acoustic neuroma, otitis media, aminoglycoside toxicity, perilymphatic fistula, Ramsey Hunt syndrome
- Central causes: vestibular migraine, brainstem ischemia, cerebellar infarction or hemorrhage, chiari malformation, multiple sclerosis
— Characteristic physical findings for peripheral etiologies include horizontal or horizontal-torsional nystagmus which suppresses with visual fixation, whereas with central etiologies, characteristic findings include horizontal, vertical or torsional nystagmus which does not suppress with visual fixation
— MRI is only indicated if there is a high clinical suspicion for central causes and exam with pertinent neurological findings