Vertigo - a false sense of movement. If you want to experience vertigo sit on an office chair and ask a friend to rotate you around 10 times and then open your eyes. Congratulations You are experiencing vertigo
- Benign paroxysmal positional vertigo: vertigo brought on by changes in head position. Attack lasts < 1 minute. Elderly patients. Small crystals in SCC canals. Diagnose with Dix-Hallpike test. Treat with Epley Manoeuvres
- Vestibular Neuritis/Labyrinthitis - infection, injury, vascular: Acute severe vertigo with nausea and vomiting. May need steroids. Can take weeks even months to resolve. May need MRI.
- Meniere's disease: Older patient, tinnitus, hearing loss, attacks of vertigo. Low-frequency hearing loss. Consider medications and ENT review.
- Aminoglycoside toxicity e.g. Gentamicin
- Vestibulocochlear lesion
- Brainstem/Cerebellar stroke or TIA: Look for weakness, Horner's and ataxia. Needs an MRI scan. A stroke usually gives ongoing symptoms and most commonly lateral medullary syndrome.
- Demyelination e.g. Multiple Sclerosis or Acute Disseminated Encephalomyelitis: Attacks lasting for several days with possibly other brainstem signs
- Space occupying lesion: progressive vertigo with brainstem and other symptoms depending on the exact location. May be associated with deafness. Needs MRI
- Migraine aura: recurrent attacks fine between, headache, tingling and other positive phenomena. Often young, female. Diagnosis when MRI and other tests normal.