Vertigo in children

Abstract

Vertigo is a subjective feeling of spinning or a state of loss of balance in space, often associated with nausea, headache and vomiting, uncertainty and drifting while walking. Vertigo indicates damage to the central or peripheral vestibular system. Hearing loss and tinnitus with vertigo usually indicate peripheral damage affecting the inner ear (labyrinth). The vestibulospinal system enables orientation in space, control of movement balance, stabilization and fixation of the image of objects in the eyes. Central (intracranial) damage to the ves-tibular system is associated with dysarthria, dysphagia, diplopia and hemiparesis. The most common causes of central damage are neurovascular, demyelinating diseases, head injuries, and brain tumors. The most common cause of central vertigo is vestibular migraine. Dizziness associated with pronounced autonomic symptoms such as vomiting, sweating, pallor and nausea point primarily to damage to the peripheral vestibular system. Benign paroxysmal vertigo (BPV) and labyrinthitis are the most common causes of peripheral vertigo and are associated with peripheral damage to the vestibular system. Acute vertigo is associated with vestibular neuritis, demyelinat-ing disease, stroke, CNS infection, and head trauma. Subacute and chronic vertigo appear in expansive intracranial processes of the posterior cranial fossa and in the context of toxic damage to the vestibular system. A rational diagnostic approach to a child with vertigo of peripheral and central etiology is primarily based on detailed anam-nestic data and a detailed neurological status. Diagnostic algorithms/procedures and a differential diagnostic approach are proposed, which enable the rationalization of examinations in children with peripheral and central causes of vertigo.