Lightheadedness and vertigo classification

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## Overview

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Vertigo is typically classified into one of two categories depending on the location of the damaged vestibular pathway. These are peripheral or central vertigo. Each category has a distinct set of characteristics and associated findings. Vertigo can also occur after long flights or boat journeys where the mind gets used to turbulence, resulting in a person feeling as if they are moving up and down. This usually subsides after a few days.

## Classification

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### Classification Based Upon Location of Dysfunction

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#### Peripheral

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Vertigo caused by problems with the inner ear or vestibular system, which is composed of the semicircular canals, the vestibule (utricle and saccule), and the vestibular nerve is called "peripheral", "otologic" or "vestibular" vertigo.[1] The most common cause is benign paroxysmal positional vertigo (BPPV), which accounts for 32% of all peripheral vertigo.[1] Other causes include Ménière's disease (12%), superior canal dehiscence syndrome, labyrinthitis and visual vertigo.[1][2] Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient vertigo if it involves the inner ear, as may chemical insults (e.g., aminoglycosides)[3] or physical trauma (e.g., skull fractures). Motion sickness is sometimes classified as a cause of peripheral vertigo.

Patients with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, fullness, and pain in the ear.[1] In addition, lesions of the internal auditory canal may be associated with ipsilateral facial weakness.[1] Due to a rapid compensation process, acute vertigo as a result of a peripheral lesion tends to improve in a short period of time (days to weeks).[1]

#### Central

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Vertigo that arises from injury to the balance centers of the central nervous system (CNS), often from a lesion in the brainstem or cerebellum and is generally associated with less prominent movement illusion and nausea than vertigo of peripheral origin.[4] Central vertigo has accompanying neurologic deficits (such as slurred speech and double vision), and pathologic nystagmus (which is pure vertical/torsional).[1][4] Central pathology can cause disequilibrium which is the sensation of being off-balance. The balance disorder associated with central lesions causing vertigo are often so severe that many patients are unable to stand or walk.[1]

A number of conditions that involve the central nervous system may lead to vertigo including: lesions caused by infarctions or hemorrhage, tumors present in the cerebellopontine angle such as a vestibular schwannoma or cerebellar tumors,epilepsy, cervical spine disorders such as cervical spondylosis, degenerative ataxia disorders, migraine headaches, lateral medullary syndrome, Chiari malformation,multiple sclerosis, parkinsonism, as well as cerebral dysfunction.[1] Central vertigo may not improve or may do so more slowly than vertigo caused by disturbance to peripheral structures.[1]

## References

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1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Karatas, M (2008). "Central Vertigo and Dizziness". The Neurologist. 14 (6): 355–364. doi:10.1097/NRL.0b013e31817533a3. PMID 19008741.
2. ↑ Guerraz, M. (2001). "Visual vertigo: symptom assessment, spatial orientation and postural control". Brain. 124 (8): 1646&ndash, 1656. doi:10.1093/brain/124.8.1646. PMID 11459755.
3. ↑ Xie, J; Talaska, AE; Schacht, J (2011). "New developments in aminoglycoside therapy and ototoxicity". Hearing research. 281 (1–2): 28–37. doi:10.1016/j.heares.2011.05.008. PMC 3169717. PMID 21640178.
4. ↑ 4.0 4.1 Dieterich, Marianne (2007). "Central vestibular disorders". Journal of Neurology. 254: 559–568. doi:10.1007/s00415-006-0340-7.

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