How is central vertigo diagnosed?

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How is central vertigo diagnosed?

Diagnosing central vertigo involves a thorough evaluation to distinguish it from peripheral vertigo and to identify the underlying cause within the central nervous system. The process typically includes a combination of patient history, physical examination, specialized tests, and imaging studies. Here’s a detailed overview of how central vertigo is diagnosed:

1. Detailed Medical History

Symptom Description: The doctor will ask about the nature of your vertigo, including when it started, how often it occurs, how long it lasts, and whether anything triggers or worsens it. Central vertigo often presents with additional neurological symptoms such as double vision, difficulty swallowing, or headaches.
Associated Symptoms: The presence of other symptoms, such as headaches, visual disturbances, difficulty with coordination, weakness, numbness, or speech difficulties, can suggest a central origin.
Past Medical History: Any history of neurological conditions, such as migraines, multiple sclerosis, or previous strokes, will be important to note. Previous head injuries or known brain abnormalities are also relevant.
Medication and Substance Use: Information about current medications, including those known to affect the central nervous system, as well as alcohol or drug use, can provide clues to the diagnosis.

2. Physical and Neurological Examination

Eye Movements (Nystagmus): The doctor will check for nystagmus, which is involuntary eye movement often associated with vertigo. In central vertigo, nystagmus is typically vertical or rotational and may not improve when focusing on a fixed point, unlike in peripheral vertigo.
Gait and Balance: The doctor will assess your ability to walk and maintain balance. Unsteady gait, difficulty walking in a straight line, or poor coordination may indicate a central cause.
Cranial Nerve Examination: This involves checking the function of the cranial nerves, which control muscle movements in the face, eyes, and mouth. Abnormalities here may point to a central nervous system issue.
Coordination Tests: The doctor may conduct tests like finger-to-nose or heel-to-shin to evaluate coordination, which can be impaired in central vertigo.
Hearing Tests: Although hearing loss is more associated with peripheral vertigo, checking for hearing function helps rule out peripheral causes and assess for any neurological involvement.

3. Specialized Diagnostic Tests

Vestibular Function Tests:
- Videonystagmography (VNG): This test uses video goggles to record eye movements while you follow visual targets or change head positions. It helps differentiate between central and peripheral vertigo.
- Caloric Testing: In this test, warm or cold water or air is introduced into the ear to stimulate the inner ear and provoke nystagmus. Abnormal responses may indicate a central issue.
Audiometry: A hearing test is often performed to check for hearing loss or other auditory issues that might help distinguish between central and peripheral vertigo.

4. Imaging Studies

Magnetic Resonance Imaging (MRI): MRI, especially with contrast, is the preferred imaging modality for diagnosing central vertigo. It provides detailed images of the brainstem, cerebellum, and other areas of the brain where central vertigo originates. MRI can identify conditions like strokes, tumors, multiple sclerosis, and structural abnormalities like Chiari malformation.
Computed Tomography (CT) Scan: A CT scan is less detailed than an MRI but may be used in emergency situations to quickly assess for bleeding, tumors, or fractures that could cause central vertigo.
Magnetic Resonance Angiography (MRA): MRA is a type of MRI that focuses on blood vessels and can help diagnose vascular causes of central vertigo, such as vertebrobasilar insufficiency or aneurysms.

5. Electroencephalogram (EEG)

Brain Activity Monitoring: An EEG records the electrical activity of the brain and may be used if seizures are suspected to be the cause of vertigo. Abnormal electrical patterns can indicate epilepsy or other seizure-related conditions.

6. Lumbar Puncture (Spinal Tap)

Cerebrospinal Fluid Analysis: If an infection (like encephalitis) or multiple sclerosis is suspected, a lumbar puncture may be performed to analyze cerebrospinal fluid for signs of inflammation, infection, or demyelination.

7. Blood Tests

Screening for Infections or Metabolic Disorders: Blood tests might be used to check for infections, autoimmune diseases, metabolic disorders (like thyroid issues), or other systemic conditions that could contribute to central vertigo.

8. Referral to Specialists

Neurologist Consultation: If central vertigo is suspected, a referral to a neurologist is often made for further evaluation and management.
Neuro-otologist: A specialist in both neurology and otology (ear disorders) may be consulted for complex cases that involve both the central nervous system and the vestibular system.

9. Differential Diagnosis

Ruling Out Peripheral Causes: The diagnostic process will also involve ruling out peripheral causes of vertigo, such as benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular neuritis, to confirm a central origin.

10. Observation and Follow-Up

Monitoring Symptoms: In some cases, the diagnosis may require observing the progression of symptoms over time and monitoring responses to initial treatments.

Diagnosing central vertigo can be complex and often requires a multidisciplinary approach. Early and accurate diagnosis is crucial, as the underlying causes of central vertigo can be serious and require prompt treatment.