Central Vertigo

Cerebellar Hemorrhage and Infarction

Vertigo can be the initial symptom of a CNS process including cerebellar bleed or infarction. An intracranial process should be suspected in older patients, particularly those at risk for vertebrobasilar artery disease. Neurologic findings should further this suspicion, since their presence is specific, but not sensitive, for a CNS process. Symptoms may vary little with position. A complete neurologic exam that includes gait testing is essential.

Causes

• If you have vertigo, then it may cause migraine headaches and presyncopal lightheadedness.
• If you have problem with the portion of the inner ear that controls balance then peripheral vertigo occurs.
• Central vertigo occurs if there is a an abnormality in the brain, particularly in the brainstem or the cerebellum.

Symptoms

• Vertigo may be minimal and be the only symptom ++, generally not significantly positional.
• Symptoms associated with pathologic conditions of the posterior circulation (clumsiness, weakness, change in speech) are variably present.
• Altered level of consciousness is uncommon.

Signs

• Neurologic findings are variably present and may indicate neurologic dysfunction in vertebrobasilar arterial distribution (e.g., dysmetria, dysarthria, facial palsy, ataxia).
• Nystagmus that has no latency period with lateral gaze, is nonfatiguing, or multidirectional suggests a central process.

Treatment

• For the treatment of migraine-associated vertigo such as includes analgesics and vestibular suppressants. Drugs that are useful in the treatment of migraines such as include sumatriptan, propranolol, imipramine, amitriptyline, and nortriptyline and vestibular suppressants diazepam and alprazolam.
• You should try to be avoided head positions that may cause vertigo. Use caution in situations such as driving or operating heavy equipment, where even short episodes of vertigo may be dangerous.
• Your doctor may start your treatment from bed rest or prescribing medications that suppress the activity of the inner ear, such as include meclizine, dimenhydrinate or promethazine, anticholinergic medications such as include scopolamine or a tranquilizer.
• You can also use vestibular rehabilitation therapy (VRT) to treat vertigo. It is a type of physical therapy. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system.