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How is central vertigo diagnosed?
Diagnosis of central vertigo involves a combination of neurological examination, tests, and imaging studies. The process helps to differentiate central vertigo (caused by the brainstem or cerebellum) from peripheral vertigo (caused by the vestibular nerve or inner ear). The following is how central vertigo is typically diagnosed:
1. Medical History and Symptom Evaluation
The doctor will begin by taking a complete medical history and asking about your symptoms. This includes:
Onset and duration of the vertigo.
Associated symptoms, e.g., diplopia, nausea, dysarthria, or weakness.
Whether continuous or elicited by certain movements or positions.
Any history of previous neurological disease, i.e., stroke, multiple sclerosis, or head injury.
The findings of central vertigo will usually consist of other neurological abnormalities, which may shed light on the etiology.
2. Neurological Examination
Function of your central nervous system will be assessed by a neurological examination. This establishes whether the central, rather than peripheral, origin of the vertigo is able to be established.
Eye movements: Abnormalities of eye movement, such as nystagmus (abnormal eye movement), are tested for by the doctor and may be due to difficulties in the brainstem or cerebellum.
Nystagmus in central vertigo is vertical or multi-directional, while in peripheral vertigo it is horizontal or torsional.
Coordination and balance: Your doctor will check for ataxia (lack of ability to coordinate muscle movements), which can suggest cerebellar involvement.
Reflexes: Your doctor will examine your reflexes to determine any abnormalities, which can indicate brainstem malfunction.
Speech and swallowing: Dysarthria (speech difficulty) or dysphagia (swallowing difficulty) may point towards central causes, particularly with brainstem involvement.
Strength and sensation: Weakness, numbness, or alteration of sensation on one side of the body may imply stroke or other central nervous system disease.
3. Dix-Hallpike Test (Exclusion Test)
While utilized primarily to diagnose BPPV (a peripheral etiology of vertigo), the Dix-Hallpike test can also be utilized to exclude peripheral vertigo and direct attention to central etiologies. If the test is not symptomatic or is atypically symptomatic, it may indicate that the vertigo is central.
4. Imaging Tests
As central vertigo is most often due to neurological disorders such as strokes, tumors, multiple sclerosis, or infections, imaging tests are required to determine the underlying cause.
Magnetic Resonance Imaging (MRI): MRI is the imaging test of choice for central vertigo because it provides very good pictures of the brainstem and cerebellum, where the problem may be located.
MRI can detect brain tumors, strokes, multiple sclerosis plaques, or vascular malformations.
Computed Tomography (CT) scan: A CT scan may be used if an MRI is not available or the doctor suspects acute causes such as stroke. CT scans are faster than MRIs and can detect bleeding in the brain.
5. Blood Tests
Blood tests may be prescribed to rule out some of the conditions that may cause central vertigo, such as:
Infections (e.g., Lyme disease, viral infections of the brain).
Metabolic disturbances (such as low blood sugar, electrolyte imbalance).
Blood clotting disorders (in case the doctor suspects a stroke or other vascular issue).
6. Additional Tests (If Needed)
Electronystagmography (ENG) or Videonystagmography (VNG): These are tests of eye movements and can help determine if the vertigo is accompanied by nystagmus. The pattern of nystagmus in central vertigo can provide information about whether the cerebellum or the brainstem is involved.
Cerebral Angiography: In some patients, if vascular causes (e.g., stroke, aneurysms) are suspected, cerebral angiogram can be used to outline blood flow in the arteries and veins of the brain.
7. Referral to Specialists
If the doctor feels that the vertigo could be secondary to a more complex neurological disorder, he or she can refer you to a neurologist or neuro-otologist for treatment and evaluation.
Summary of Diagnostic Approach
Medical history and review of symptoms: Identifying the nature of your vertigo and associated neurological symptoms.
Neurological examination: Checking reflexes, eye movements, coordination, and muscle strength.
Exclusion of peripheral vertigo: Performing tests like the Dix-Hallpike test to rule out inner ear causes.
Imaging (MRI or CT): Identifying potential brain-related causes, such as stroke, tumors, or multiple sclerosis.
Blood tests and other investigations: Ruling out infections, metabolic disturbances, and clotting disorders.
Conclusion
Central vertigo needs to be diagnosed with a good evaluation of your symptoms, comprehensive neurological examination, and advanced imaging studies such as MRI or CT scans. An early diagnosis is necessary because central vertigo could be a manifestation of serious underlying diseases like stroke or brain tumor, which need emergent treatment. If you experience persistent vertigo with neurological findings, medical evaluation as quickly as possible is important.
Would you like more information about some diagnostic tests or some treatment options for central vertigo?
Treatment of central vertigo depends on the underlying cause because central vertigo is due to brainstem or cerebellum disorders, which require a more delicate approach. The following are the primary treatment options based on the underlying cause of central vertigo:
1. Medications
Medications may be used to treat symptoms of vertigo, nausea, and other associated problems:
Antihistamines: Drugs like meclizine or dimenhydrinate may be helpful in the reduction of dizziness and nausea, though they are typically more effective for peripheral vertigo, at times they will also produce relief in central vertigo.
Benzodiazepines: Medications like diazepam may be used in certain cases to manage vertigo symptomatology, particularly if the symptomatology is being secondary to anxiety or tension.
Antiemetics: Medications like ondansetron may be prescribed to control nausea from vertigo, especially if dizziness causes significant nausea.
Corticosteroids: If the vertigo is an inflammatory condition, such as with autoimmune disease or multiple sclerosis, corticosteroids like prednisone can be prescribed to address inflammation in the brain and spinal cord.
Antidepressants or Anticonvulsants: In multiple sclerosis or vestibular migraines, medications like tricyclic antidepressants or anticonvulsants (e.g., gabapentin) may be employed to treat vertigo attacks.
2. Physical Therapy and Rehabilitation
Vestibular rehabilitation therapy (VRT) is an important treatment for central vertigo, particularly if the vertigo is followed by dysfunction of the vestibular system (balance center) in the cerebellum or brainstem:
Vestibular Rehabilitation Therapy (VRT): Individualized exercises and balance retraining may help improve the brain’s ability to compensate for balance disturbances due to central vertigo. It includes exercises that are designed to improve coordination, balance, and overall mobility.
Gaze Stabilization Exercises: These exercises help condition the brain to stabilize balance and fixation as the body moves.
Balance Training: Some exercises may be directed toward improving posture and stability, most often in addition to other activities that are specifically designed to enhance balance in functional situations.
3. Treatment of Underlying Conditions
Treatment of the underlying cause of central vertigo is the optimal approach. Some treatments may involve:
Stroke or TIA: Urgent medical attention needs to be sought when vertigo is caused by a stroke or transient ischemic attack (TIA). This may include blood thinners (anticoagulants), antiplatelet drugs, or surgical interventions to remove obstruction or fix problems with the blood vessels.
Multiple Sclerosis (MS): MS is treated with disease-modifying drugs (DMTs) to slow the course of disease. These medications, for example, interferons or glatiramer acetate, manage symptoms and suppress relapses, reducing the likelihood of episodes of vertigo.
Brain Tumors: If vertigo is caused by a brain tumor, treatment may include surgery, radiation therapy, or chemotherapy to remove or reduce the size of the tumor and alleviate associated symptoms.
Cerebellar Ataxia: Cerebellar ataxia is not curable, but symptomatic management like physical therapy and speech therapy may improve quality of life. Immune-modulating therapy may be attempted under specific circumstances if the ataxia is autoimmune in nature.
Infections: Antiviral or antibiotic treatment would be attempted in the case of infection within the brainstem or cerebellum, if vertigo is caused by infection (e.g., encephalitis or cerebellitis).
Migraines: Treatment for vestibular migraines-induced vertigo would include migraine-specific drugs like triptans, beta-blockers, or antidepressants to reduce the severity and frequency of migraine attacks and preventive treatments like avoiding triggers.
4. Cognitive and Behavioral Approaches
In others, especially those with disorders like vestibular migraines, MS, or stroke, management of stress and anxiety can regulate the frequency and severity of vertigo attacks
Cognitive Behavioral Therapy (CBT): CBT may be helpful in managing the psychological impact of vertigo, especially if the condition causes anxiety or emotional distress. It can assist one in acquiring coping skills and relaxation techniques.
Mindfulness and Relaxation Techniques: Deep breathing, yoga, and progressive muscle relaxation can reduce stress and anxiety, which can worsen vertigo symptoms.
5. Surgery (in Severe Cases)
In very serious cases of central vertigo, especially due to structural issues like brain tumors or severe vestibular dysfunction, surgery may be necessary:
Surgery for Brain Tumors: Surgery might be necessary if a brain tumor is causing vertigo, either to remove the tumor or to reduce pressure on the brain.
Vascular Surgery: When vertigo is precipitated by disturbances in blood supply to the brain (e.g., in some strokes), endovascular intervention or vascular surgery might be indicated.
Deep Brain Stimulation: In some instances of neurodegenerative disease like Parkinson’s disease, symptoms including those from balance can be controlled by the use of deep brain stimulation.
6. Support and Lifestyle Modification
In addition to medication treatments, lifestyle modifications also help in managing vertigo and its effects:
Avoiding Triggers: Getting away from triggers of conditions like migraines or vestibular migraines can stop vertigo attacks.
Hydration: Adequate hydration is necessary in order to prevent dizziness and maintain balance, especially in disorders like stroke or vestibular migraine.
Dietary Changes: In a few cases, management of underlying disorders like migraines by dietary modification (avoiding certain food or alcohol) can be helpful in controlling vertigo.
Support Systems: Having a good support system of family, friends, and caregivers can help manage the emotional and psychological impacts of suffering from chronic vertigo.
Conclusion
Treatment of central vertigo addresses the underlying systemic or neurological cause and may be done with medication, physical therapy, surgery, or modification in lifestyle. The proper and early diagnosis plays a critical role in identifying the ideal treatment strategy. In most individuals, the ideal way of managing symptoms and improving quality of life is a multidisciplinary approach that includes medical management, rehabilitation, and psychological support.
If you or someone around you have recurrent vertigo along with other neurological symptoms, then consultation with a vestibular specialist or neurologist is required for proper diagnosis and treatment.
Would you like information on any specific treatment or etiology of central vertigo?
The Stop Snoring And Sleep Apnea Program™ a well-researched program created to help stop snoring and sleep apnea so that you can have a good night sleep. The techniques that you will learn from this program works immediately. It will only take you 3-7 minutes to perform these simple exercises that the author has recommended but the results that you will get will help you have a good night sleep as soon as tonight. Within a week, snoring will be a thing of the past.