Vertigo

 Q: 62 years old male is admitted to ICU with hypovolemic shock and electrolyte imbalance. Patient is experiencing symptoms of vertigo associated with severe nausea and vomiting (NV). Severe NV is more likely with? (select one)

A) central vertigo 

B) peripheral vertigo

Answer: A

Vertigo is broadly divided into two types:

• Central vertigo as the name implied is due to lesions in the central nervous system (CNS)
• Peripheral vertigo is likely due to origin from the inner ear

The objective of the question is to emphasize the role of history taking in the complex phenomenon of vertigo. Like, central vertigo with vertebrobasilar insufficiency usually lasts only for few minutes but peripheral vertigo is likely to be occurring for hours. This assessment is vital as patients with central lesions i.e., stroke, hemorrhage, or multiple sclerosis (MS) may require quick imaging and neuro team involvement. 

About 20 percent of ischemic strokes affect the posterior circulation due to ischemia of the posterior inferior cerebellar or the vertebral artery. In suck strokes, central vertigo may be the only presenting symptom. 

#Neurology

#ENT

 References:

1. Baloh RW. Differentiating between peripheral and central causes of vertigo. Otolaryngol Head Neck Surg. 1998 Jul;119(1):55-9. doi: 10.1016/S0194-5998(98)70173-1. PMID: 9674515.

2. Huon LK, Wang TC, Fang TY, Chuang LJ, Wang PC. Vertigo and stroke: a national database survey. Otol Neurotol. 2012 Sep;33(7):1131-5. 

3. Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, Baloh RW. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006 Oct 10;67(7):1178-83. 

4. Hacke W, Zeumer H, Ferbert A, Brückmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988 Oct;19(10):1216-22.