What is central vertigo?

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Central vertigo is a type of vertigo that originates from a problem in the central nervous system, specifically the brain, rather than from issues in the inner ear or peripheral vestibular system. This form of vertigo is often more serious than peripheral vertigo, which is typically related to disorders of the inner ear, such as benign paroxysmal positional vertigo (BPPV) or M?ni?re’s disease.

Causes of Central Vertigo

Central vertigo can be caused by various conditions affecting the brain, including:

Migraine-Associated Vertigo (Vestibular Migraine)
- This type of migraine can cause vertigo as a primary symptom, often accompanied by other migraine symptoms like headache, sensitivity to light and sound, and visual disturbances.
Stroke or Transient Ischemic Attack (TIA)
- A stroke or TIA can impair blood flow to areas of the brain that control balance and spatial orientation, leading to sudden and severe vertigo.
Multiple Sclerosis (MS)
- MS can damage the central nervous system, including areas involved in balance and coordination, resulting in vertigo among other symptoms.
Brain Tumors
- Tumors in the brain, especially those affecting the cerebellum or brainstem, can cause vertigo due to pressure or disruption of normal brain function.
Trauma
- Head injuries can damage the brain areas responsible for balance and coordination, leading to vertigo.
Infections and Inflammations
- Conditions such as encephalitis (inflammation of the brain) or meningitis (inflammation of the protective membranes covering the brain and spinal cord) can cause central vertigo.
Chiari Malformation
- This structural defect involves the displacement of brain tissue into the spinal canal, which can affect balance and coordination, causing vertigo.
Epilepsy
- Certain types of epilepsy can have vertigo as a symptom, particularly when seizures originate in the temporal lobe, which is involved in processing balance and spatial orientation.

Symptoms of Central Vertigo

The symptoms of central vertigo can differ from those of peripheral vertigo and may include:

Intense and Persistent Dizziness
- Unlike peripheral vertigo, which often comes and goes with head movements, central vertigo can be more continuous and less dependent on head positioning.
Nausea and Vomiting
- These symptoms can occur but are typically less severe than in peripheral vertigo.
Neurological Symptoms
- Symptoms such as double vision, difficulty speaking, weakness or numbness in limbs, and difficulty swallowing can accompany central vertigo, indicating a potential neurological issue.
Gait and Balance Problems
- Patients may experience difficulty walking or standing, and they might exhibit unsteady gait or coordination problems.
Headache
- Particularly in the case of vestibular migraines, headaches can accompany vertigo.
Nystagmus
- This involuntary, rapid eye movement may occur, but it often differs in pattern from that seen in peripheral vertigo.

Diagnosis of Central Vertigo

Diagnosing central vertigo typically involves a combination of:

Medical History and Symptom Review
- A thorough review of the patient’s symptoms, medical history, and potential risk factors (such as previous head injuries or neurological conditions).
Physical and Neurological Examination
- A comprehensive examination to assess balance, coordination, eye movements, and other neurological functions.
Imaging Studies
- MRI or CT scans of the brain can help identify structural abnormalities, tumors, strokes, or other causes of central vertigo.
Blood Tests and Other Diagnostic Tests
- These may be conducted to check for infections, inflammatory markers, or other underlying conditions.

Treatment of Central Vertigo

Treatment for central vertigo depends on the underlying cause and may include:

Medications
- For conditions like vestibular migraines, medications such as triptans, beta-blockers, or antiepileptic drugs may be used. In cases of stroke, antithrombotic medications or surgical interventions may be necessary.
Vestibular Rehabilitation Therapy (VRT)
- This form of physical therapy can help improve balance and reduce dizziness.
Surgery
- In cases involving tumors, Chiari malformation, or other structural issues, surgical intervention may be necessary.
Management of Underlying Conditions
- For conditions like multiple sclerosis or infections, specific treatments aimed at managing the disease can help alleviate vertigo symptoms.
Lifestyle Modifications and Supportive Therapies
- In some cases, lifestyle changes, such as stress management, dietary adjustments, and supportive therapies like cognitive behavioral therapy, can be beneficial.

When to Seek Medical Attention

Central vertigo can be a sign of serious underlying conditions. Immediate medical attention is crucial if vertigo is accompanied by:

Sudden and severe headache
Double vision or vision loss
Difficulty speaking or understanding speech
Weakness or numbness, especially on one side of the body
Difficulty walking or loss of coordination
Loss of consciousness or severe confusion

Central vertigo involves dizziness or spinning sensations originating from the central nervous system, often indicating a potentially serious underlying condition. Proper diagnosis and treatment are essential to address the root cause and prevent complications. If experiencing symptoms of central vertigo, it is crucial to seek medical evaluation and appropriate treatment.