Vertigo

BASICS

DESCRIPTION

Vertigo is the illusory sensation of movement and is a symptom of many underlying conditions.

  • Commonly experienced as a spinning, rocking, swaying, or tilting sensation
  • Should be distinguished from general lightheadedness or presyncope
  • Can arise from disturbances of the peripheral vestibular system or central nervous system (CNS)
  • Time course, duration, frequency of episodes, triggers, and associated symptoms may vary and will help identify the underlying diagnosis.

EPIDEMIOLOGY

  • Prevalence of dizziness and imbalance in children estimated to be about 5%
  • Younger children may present with imbalance or reading difficulty, whereas adolescents more commonly report dizziness or vertigo.

ETIOLOGY

  • Common central causes of vertigo and dizziness include the following:
    • Vestibular migraine
    • Benign recurrent vertigo of childhood (BRVC)
    • Concussion
    • Motion sickness
  • More rare causes in children include the following:
    • CNS tumors
    • Infections
    • Stroke
    • Seizure disorders
  • Peripheral vestibular disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, chronic otitis media, inner ear malformations, and temporal bone fractures.
  • Meniere disease, seen more frequently in adult patients with vertigo, is relatively rare in the pediatric population.
  • Other nonvestibular conditions may cause dizziness which patients might describe as vertigo. These include cardiac and autonomic disorders, ocular and oculomotor abnormalities, toxic-metabolic conditions (e.g., poisoning, drug and medication side effects), and psychiatric conditions.

RISK FACTORS

  • Head trauma
  • Exposure to ototoxic drugs
  • Ear surgeries
  • Prior episodes of vertigo

Genetics

Numerous rare genetic disorders and syndromes can affect balance including cerebellar ataxia disorders and peripheral vestibular disorders (e.g., Usher syndrome or CHARGE [coloboma, heart defects, atresia choanae, growth retardation, ear anomalies] syndrome). Often, these patients will not complain of vertigo but will present with imbalance and discoordination.

PATHOPHYSIOLOGY

  • Balance function relies on sensory inputs from the vestibular organs (utricle, saccule, and semicircular canals), eyes, and somatosensory systems.
    • Signals are integrated in the brainstem and processed with information from cerebellum and cerebral cortex.
    • Brainstem transmits motor outputs to the spinal cord, extraocular muscles, and neck musculature to stimulate the vestibulospinal, vestibuloocular, and vestibulocollic reflexes that maintain head and postural control and stabilize gaze.
  • Vertigo results from dysfunction of either the peripheral or central vestibular systems.

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