Introduction
Methods
Results
Study, country | Age range | Study design | Time frame | No. of subjects | Comments |
---|---|---|---|---|---|
Lanzi G. et al., 1994 [12] Italy | 12.5 to 24.2 years. old | Prospective study | Not specified | 47 | Vertigo is a rare symptom in patients with juvenile migraine |
Salman MS. et al., 2017 [13] Canada | 6 to 32.75 years old | Retrospective study | 1991 to 2008 | 185 | Vertigo/dizziness are often associated with chronic ataxia. Genetic, metabolic and inflammatory disorders should be considered in these patients |
Langhagen T. et al., 2013 [14] Germany | 1.4 to 18 years old | Retrospective study | November 2009 to April 2012 | 168 | Migraine-related vertigo is the most common cause of vertigo and dizziness in children and adolescents |
Ramantani G. et al., 2009 [15] Germany | 9 years old | Case report | Not specified | 1 | Episodes of vertigo can be rarely associated with tuberous sclerosis |
Caldarelli M. et al., 2007 [16] Italy | 2 months to 16 years | Retrospective study | January 1993 to August 2005 | 30 | Vertigo is a complaint presenting in 30% of pediatric patients with symptomatic Chiari malformation Type I |
Kalashnikova LA. et al., 2005 [17] Russia | 7 to 72 years | Retrospective study | Not specified | 25 | A sudden onset of vertigo can be a clinical manifestation of cerebellar infarcts |
Bucci MP. et al., 2004 [18] France | 6 to 15 years old | Prospective study | Not specified | 12 | Vertigo in children with normal vestibular function can be associated with abnormal vergence latency |
Russell G. et al., 2009 [19] Scotland | School age | Epidemiological study | Not specified | 2165 | Paroxysmal vertigo is common in childhood and it appears to cause few major problems to the affected children |
D’Agostino R. et al., 1997 [1] Italy | 4 to 14 years old | Retrospective study | 1985 to 1989 | 282 | Vertigo as isolated symptom is the most frequent clinical presentation in childhood. Paroxysmal benign vertigo is the second most frequent cause of vertigo |
Raucci U. et al., 2015 [7] Italy | 3 to 18 years old | Retrospective study | January 2009 to December 2013 | 616 | Vertigo is most frequently related to benign conditions such as migraine and syncope. Early recognition of associated signs or symptoms is mandatory to identify need for further investigations |
Lehnen N. et al., 2015 [20] Germany | 8 to 12 years old | Case report | 10-year period | 3 | Vestibular paroxysmia should be considered in children with short, frequent vertiginous episodes |
Mugundhan K. et al., 2011 [21] India | 13 to 65 years old | Case report | Not specified | 5 | The presence of recurrent episodes of vertigo is typical in familial episodic ataxia type II. Cerebellar function tests can be completely normal between the attacks |
Study, country | Age range | Study design | Time frame | No. of subjects | Comments |
---|---|---|---|---|---|
Joshi P. et al., 2020 [22] New Zealand | 28 to 65 years old | Case series | Not specified | 7 | BPPV is the most common cause of positional vertigo |
Grad A. et al., 1989 [23] USA | 40 to 81 years old | Retrospective study | 1974 to 1987 | 84 | The sudden onset of vertigo lasting minutes in a patient with known cerebrovascular disease strongly suggests an ischemic cause |
Norrving B. et al., 1995 [24] Sweden | 50 to 75 years old | Prospective study | Not specified | 24 | A caudal cerebellar infarction may easily be misdiagnosed as a labyrinthine disorder, and it is found to be the cause in one in fourpatients presenting with isolated acute vertigo |
Kim GW. et al., 1996 [25] Korea | Not specified | Prospective study | August 1994 to February 1995 | 152 | Vertigo as a manifestation of stroke may not be an infrequent symptom |
Casani AP. et al., 2013 [26] Italy | 47 to 80 years old | Retrospective study | 2007 to 2011 | 11 | Pseudo-acute peripheral vertigo is not an uncommon diagnosis in otoneurological practice |
Doijiri R. et al., 2016 [27] Japan | 56 to 79 years old | Retrospective study | 2005 to 2015 | 221 | In this study stroke was found in 11% of patients with isolated vertigo or dizziness attack. The posterior inferior cerebellar artery area is frequently implicated for isolated vertigo or dizziness |
Hesselbrock RR 2017 USA | 40 to 42 years old | Case reports | Not specified | 2 | Accurate assessment of patients with acute vestibular symptoms can be challenging, Central causes of isolated acute vestibular symptoms are uncommon |
Perloff MD. et al., 2017 [28] USA | Mean age 59.8 ± 16.7 | Retrospective study | January 2005 to January 2010 | 136 | There is an important proportion of cerebellar stroke among emergency department in patients with isolated dizziness |
Wang Y. et al., 2018 China | Mean age 58.5 ± 12.3 for central vertigo and 52.1 ± 8.8 for peripheral vertigo | Retrospective study | January 2014 to July 2016 | 87 | Patients with isolated vertigo and three or more risk factors are at higher risk for central vertigo |
Lee H. et al., 2009 [29] Korea | 23 to 93 years old | Prospective study | January 2000 to July 2008 | 82 | Labyrinthine dysfunction of a vascular cause usually leads to combined loss of both auditory and vestibular functions |
Paul NL. et al., 2012 UK | Mean age 75.9 ± 11.8 for carotid stroke and 73.3 ± 13.1 for vertebrobasilar stroke | Prospective study | April 2002 to March 2010 | 1141 | In patients with vertebrobasilar stroke, preceding transient isolated brainstem symptoms are common but rarely satisfy traditional definition of TIA |
Lee SU. et al., 2015 [30] Korea | 33 to 73 years old | Retrospective study | 2003 to 2014 | 18 | Presence of central vestibular signs allows bedside differentiation of isolated vestibular syndrome |
Parthasarathy R. et al., 2016 [31] Canada | 76 years old | Case report | Not specified | 1 | Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is likely a cause for intermittent vertigo |
Lee H. et al., 2002 [32] Korea | 17 to 74 years old | Prospective study | March 2000 to July 2001 | 72 | Migraine should be considered in the differential diagnosis of isolated recurrent vertigo of unknown cause |
Kim DD. et al., 2019 [33] Canada | 60 s years old | Case report | 2019 | 1 | Chronic naturopathic over- the-counter products intake may cause a subacute progressive cerebellar syndrome manifesting also with vertigo |
Adzic-Vukicevic T. et al., 2019 [34] Serbia | 66 years old | Case report | 2019 | 1 | Cryptococcosis may present even in immunocompetent patients and may show central nervous system involvement with vertigo |
Pula JH. et al., 2013 [35] USA | 19 to 55 years old | Prospective observational study | 1999 to 2011 | 7 | Multiple sclerosis is an uncommon cause of acute vestibular syndrome |
Kremer L. et al., 2014 [36] France, USA, UK, Japan, Canada, Germany | Mean age 44.2 | Prospective observational study | Not specified | 258 | Brainstem involvement occurs in about one-third of patients with NMO and NMOSD; vertigo or vestibular ataxia occur in 1.7% of patients |
Lee JY. et al., 2019 [37], Korea | 20 to 80 years old | Retrospective analysis | January 2012 to January 2015 | 133 | Vestibular neuritis is characterized of rotational vertigo that last for over a day but the clinical course and the characteristics depends on the involvement site of the nerve |
Roberts RA., 2018 [38] USA | 60 years old | Case report | Not specified | 1 | Patients using biologic disease-modifying antirheumatic drugs could be at an increased risk for recurrent vestibular neuritis, with possible viral pathogenesis |
Unal M. et al., 2006 [39] | 51 years old | Case report | Not specified | 1 | It is important to consider Arnold-Chiari type I malformation in the differential diagnosis of adult vertigo cases |
Spacey S.et al., 2003 | 2 to 32 years old | Review | Not specified | Not specified | Episodic ataxia type 2 (EA2) is characterized by paroxysmal attacks of ataxia, vertigo, and nausea. Onset is typically in childhood or early adolescence |
Rispoli MG. et al., 2019 [40] | 71 years old | Case report | March 2015 | 1 | New missense mutation in the ATP1A2 gene is associated with atypical sporadic hemiplegic migraine, a disease possibly manifesting with vertigo |
Di Stefano V. et al., 2020 [41] | 71 years old | Case report | Not specified | 1 | A rare case of atypical BHS due to compression of non-dominant vertebral artery with anatomical variants, resulting in stereotyped and reversible PICA syndrome |
Potter BJ. et al., 2014 [42] | 90 years old | Case report | Not specified | 1 | A subclavian steal syndrome may occur when a significant stenosis in the subclavian artery compromises distal perfusion to the internal mammary artery, vertebral artery, or axillary artery |
Jiang Y. et al., 2020 [43] | 34 years old | Case report | Not specified | 1 | Frontal lobe epilepsy is a common neurological disorder with a broad spectrum of symptoms; it rarely presents with vertigo |
Differential Diagnosis | Incidence/Prevalence | Main Features | Clues for Differential | Examination Required | References |
---|---|---|---|---|---|
Cephalalgia | |||||
Vestibular migraine | 24% Mainly > 5yo | Vestibular symptoms (rotator vertigo) temporarily with migraine Time: 5 min or 72 h | Episodic vertigo, age > 5yo, attacks lasting minutes to hours, association at least in some cases with migraine headache or migrainous phenomena | Physical exam and vestibular tests | Lanzi et al. 1994 [12], D’Agostino et al. 1997 [1], Russell et al., 1999 Langhagen T et al. 2013 [14], Raucci et al. 2015 [7] |
Benign Paroxysmal vertigo of childhood | 14 to 18% Mainly < 5yo F > M | Episodic syndrome with short, non-epileptic, recurrent attacks of subjective or objective vertigo, which resolve spontaneously | Episodic vertigo, age < 5yo, attacks lasting seconds to minutes (to hours) without migraine headache | Clinical exam and instrumental investigations (absence of hearing impairment) | D’Agostino et al. 1997 [1], Russell et al., 1999 [19] Langhagen T et al. 2013 [14], Raucci et al. 2015 [7] |
Brain tumour and/or malformation | |||||
Expansive endocranial pathologies and/or malformation | Rare | Vertigo, neurological symptoms, haedache | Association with additional neurologic deficits but neuroimaging is essential | Clinical exam and neuroimaging | D’Agostino et al., 1997 [1] Caldarelli M. et al., 2007 [16] Raucci et al., 2015 [7] |
Vascular diseases | |||||
Neurovascular diseases | Rare | Vertigo, neurological symptoms, sincope | Association with additional neurologic deficits but neuroimaging is essential | Clinical exam and neuroimaging | Kalashnikova et al.,2005 [17] Raucci et al., 2015 [7] |
Demyelinating diseases | |||||
Demyelinating diseases | Rare | Vertigo, multidirectional nystagmus | Association with additional neurologic deficits but neuroimaging is essential | Vestibular tests, MRI | D’Agostino et al. 1997 [1], Raucci et al. 2015 [7], Salman M. et al., 2017 [13] |
Inflammatory disease | |||||
Vestibular neuritis | 16% Mainly > 5yo and adolescents | Sudden onset of severe vertigo, sometimes associated with nausea and vomiting | Vertigo can be intensified by small changes in head position | Electronystagmography, thermal caloric testing | D’Agostino et al., 1997 [1] Raucci et al., 2015 [7] |
Others | |||||
Somatoform vertigo | 2.5 to 16% Mainly adolescent girls | Vertigo organically not sufficiently explained | Normal findings on physical exam and diagnostic evaluation | Psychiatric consultation | D’Agostino et al., 1997 [1] Raucci et al., 2015 [7] |
Head and/or cervical trauma | 7–10% of pediatric giddiness | Isolated vertigo or vertigo associated with hearing loss or others symptoms | History of previous trauma | Imaging of head/cervical chord | Raucci et al., 2015 [7] |
Orthostatic hypotension | 3–9% of pediatric giddiness | Isolated vertigo or associated with autonomic symptoms, including syncope | Sudden drop in blood pressure after change in positioning | Blood pressure measurement, tilt test | Raucci et al., 2015 [7] |
Vestibular paroxysmia | 4% of pediatric giddiness | Frequent episodes of vertigo, several times in a day, lasting for seconds to minutes, regardless of posture | Good response to carbamazepine or oxcarbazepine | Neuroimaging | Lehnen N et al., 2015 [20] |
Iatrogenic form | Rare | Rarely cause of isolated vertigo | History of drug use or abuse | None/Urine analysis/toxicology screening | D’Agostino et al., 1997 [1] |
Tuberous Sclerosis | Only report | Only one case described child with episodes of vertigo and headache | Presence of amartomas | Cranial MRI/abdomen ultrasound | Ramantani. et al. 2009 [15] |
Familial episodic ataxia type II | Rare | Stress or exercise-induced vertigo and ataxia | Carbonic anhydrase inhibitor, such as acetazolamide, produces a complete response to vertigo | Brain MRI | K. Mugundhan, 2011 [21] |
Anisometropia and other ocular abnormalities | Rare | Sensory mismatch | Resolution with ophthalmological treatment | Ophthalmological examination | Bucci M.P. et al., 2004 [18] |
Differential Diagnosis | Incidence/Prevalence | Main Features | Clues for Differential | Examination Required | References |
---|---|---|---|---|---|
Primary or secondary brain tumours | |||||
Cerebellar lymphoma | CNS lymphoma represents 2–6% of all primary brain neoplasms (1.34 cases per million people); cerebellar involvement presents in only 9% of cases | Sudden onset of vertigo associated with vomiting | Neurotological evaluation: atypical nystagmus patterns during diagnostic maneuvers may raise suspicion of central pathology | Brain MRI with contrast enhancement and biopsy | Joshi et al., 2020 [22] |
Cerebellar metastases | 98,000–170,000 cases of brain metastases/year; metastases to the cerebellum accounts for 10–15% of all brain metastasis | Onset with severe headache, associated with nausea and vomiting, followed by positional vertigo and unsteady standing | Neurotological evaluation: atypical nystagmus patterns during diagnostic maneuvers may raise suspicion of central pathology | Brain MRI with contrast enhancement | Joshi et al., 2020 [22] |
Infratentorial gliomas | Incidence of glioma is about 6.0 per 100,000 person-years; infratentorial gliomas represent 4.6% of all gliomas | Occasional attacks of vertigo and nausea lasting less than 30 seconds, related to changes in head position | Neurotological evaluation: atypical nystagmus patterns during diagnostic maneuvers may raise suspicion of central pathology | Brain MRI with contrast enhancement | Joshi et al., 2020 [22] |
Ischemic stroke | |||||
Cerebellar stroke | 2–3% of 600,000 stroke-year in the United States. Presumed stroke etiologies: atherosclerotic occlusive lesions of the vertebral artery (32%), in situ branch artery disease (25%), cardioembolism (10%), vertebral artery dissection (5%) | Sudden onset of rotational vertigo associated with neurovegetative symptoms (nausea and vomiting). Sometimes concomitant headache or unilateral hearing loss | Head Impulse Test (HIT) is positive in acute peripheral vertigo (APV) and negative in cerebellar strokes (pseudo-APV). Delayed onset of other central symptoms/signs is not uncommon | CT scan, MRI and neurotologic examination | |
Pons stroke | 7% of all ischemic strokes, 15–20% of posterior circulation ischemia. One in ten non-traumatic intracerebral hemorrhages is located in the pons | Vertigo and vomiting, falls and pointing towards the affected side, direction fixed nystagmus towards the unaffected side | Impairment of smooth pursuit eye movements may be present | MRI and neurotologic examination | |
Medulla oblongata stroke | Not found exact incidence/prevalence. In a study: annual incidence of posterior circulation infarction is 18 per 100 000 person years in an Australian study (Dewey et al. 2003) 10–20% of them may cause acute vestibular syndrome | Diverse patterns of spontaneous nystagmus, gaze-evoked nystagmus and head-shaking nystagmus, possible otolithic dysfunction, subjective visual vertical (SVV) tilt, presence of at least one component of the ocular tilt reaction (OTR) | Less than a third of patients have abnormal ocular and cervical vestibular-evoked myogenic potentials (VEMPs) in lateral medullary infarction. Abnormal VEMPs are seen in about one-half of patients in medial medullary infarction | MRI and neurotologic examination | Paul et al., 2013; Sun-Uk Lee et al., 2015; Doijiri et al., 2016 [27], Wang et al., 2018 |
Persistent trigeminal artery (PTA) | Prevalence 0.1%-0.2% of cerebral angiograms | Isolated intermittent vertigo, followed by anterior and posterior circulation ischemic strokes symptoms | CT angiography evidence of PTA and CT signs of ischemic stroke | CT angiography | Parthasarathy, et al. 2016 [31] |
Cephalalgia | |||||
Migraine | *The prevalence of migraine according to IHS criteria was higher in the isolated recurrent vertigo group (61.1%) than in the control group (10%; p < 0.01) | isolated recurrent vertigo of unknown cause | Extensive neurotological, including auditory and vestibular function testing and appropriate imaging studies | ICHD3 criteria | Lee et al., 2002 [32] |
Demyelinating disorders | |||||
Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMOSD) | The prevalence of MS in Europe is about 100–190/100.000 inhabitants; the prevalence range of NMOSD is ~ 0.5–4/100.000 worldwide | Isolated vertigo with or without nystagmus | Extensive neurotological, including auditory and vestibular function testing and MRI | Clinical exam, Brain MRI, HIT | |
Infectious | |||||
Neurocisticercosis | rare | Positional vertigo nystagmus | Cultural tests | Clinical exam, Brain MRI | Joshi et al., 2020 [22] |
Cryptococcosis | rare | Fever, vertigo | Cultural tests | Clinical exama, Laboratory tests (CSF culture) neuroimaging (CT, MRI) | Adzic-Vukicevic et al., 2019[34] |
Others | |||||
Vestibular neuritis | Unknown | Acute onset of vertigo with repetitive falls without hearing loss or tinnitus | recent viral infection | Serology for herpes virus | |
Arnold-Chiari malformation | Rare | Displacement of the cerebellar tonsils | Neuroradiology | Brain MRI | Unal M et al., 2006 [39] |
Episodic ataxia type 2 | Rare | Paroxysmal recurrent attacks of vertigo which usually respond to the treatment with potassium channel blockers and acetazolamide | autosomal dominant | Genetics | Spacey S et al., 1993 [44] |
Hemiplegic migraine | Rare | Acute attack with isolated vertigo or more often associated with hemiparesis and confusion | Clinical exam, genetic testing | Rispoli et al., 2019 [40] | |
Bowhunter’s syndrome and | Very rare | Recurrent attacks of vertigo associated with neck rotation | Neuroradiology | Dynamic MRI and neurosonology | Di Stefano et al., 2020 [41] |
Subclavian steal syndrome | Rare | Recurrent attacks of vertigo associated with the use of an arm | Neuroradiology | MRI and neurosonology | Potter et al., 2014 [42] |
Cerebellar syndrome due to naturopathic over-the-counter supplements | Only a single report | Vertigo, gait unsteadiness, nystagmus, hypermetric saccades, dysmetria, ataxia | Anamnesis of supplement use | Clinical exam, Laboratory tests, Neuroimaging | Kim DD et al., 2019 [33] |
Frontal lobe epilepsy | Rare | Seizures with onset from the frontal lobe | Antiepileptics (i.e., sodium valproate, levetiracetam, and lamotrigine) | EEG | Jiang et al., 2020 [43] |