What are the causes of central vertigo?

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What are the causes of central vertigo?

Central vertigo is caused by dysfunction or damage within the central nervous system, particularly in areas of the brain responsible for balance and spatial orientation, such as the brainstem and cerebellum. Unlike peripheral vertigo, which originates from issues in the inner ear, central vertigo is associated with more serious and complex conditions. Here are the common causes of central vertigo:

1. Stroke

Ischemic Stroke: A stroke occurs when the blood supply to a part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. If the stroke affects areas involved in balance, such as the brainstem or cerebellum, it can lead to central vertigo.
Hemorrhagic Stroke: Bleeding in the brain due to a ruptured blood vessel can also cause central vertigo, particularly if it affects the brain regions associated with balance.

2. Multiple Sclerosis (MS)

Demyelination: Multiple sclerosis is a chronic autoimmune disease that damages the myelin sheath, a protective covering of nerve fibers in the central nervous system. When MS affects the pathways in the brainstem or cerebellum that control balance, it can result in central vertigo.

3. Brain Tumors

Cerebellar Tumors: Tumors in the cerebellum or brainstem can compress or invade the neural pathways responsible for balance, leading to vertigo.
Metastatic Brain Tumors: Cancers from other parts of the body that spread to the brain can also cause central vertigo if they involve or press on areas related to balance.

4. Migraine-Associated Vertigo

Vestibular Migraine: Migraines can cause vertigo even in the absence of a headache, known as vestibular migraine. This form of central vertigo occurs due to abnormal brain activity that affects the vestibular system, which is responsible for balance.

5. Traumatic Brain Injury (TBI)

Concussion: A mild TBI, such as a concussion, can disrupt the normal function of the brainstem or cerebellum, leading to central vertigo. More severe brain injuries can also cause lasting damage to these areas, resulting in chronic vertigo.

6. Infections

Encephalitis: Inflammation of the brain caused by viral infections can lead to central vertigo, particularly if the infection affects the brainstem or cerebellum.
Brain Abscess: A localized infection in the brain that forms a pus-filled cavity (abscess) can cause central vertigo if it involves or compresses the balance centers in the brain.

7. Degenerative Neurological Disorders

Cerebellar Ataxia: This group of disorders involves the progressive degeneration of the cerebellum, leading to impaired coordination and balance. As the condition worsens, central vertigo can develop.
Progressive Supranuclear Palsy (PSP): This rare brain disorder causes problems with balance, eye movements, and cognitive function, leading to symptoms like central vertigo.

8. Epilepsy

Seizures: In some cases, epilepsy can cause vertigo during or after a seizure, especially if the seizure originates in or spreads to the areas of the brain responsible for balance.

9. Vascular Disorders

Vertebrobasilar Insufficiency: This condition occurs when blood flow to the posterior part of the brain (which includes the brainstem and cerebellum) is reduced, often due to atherosclerosis or other vascular diseases. This can lead to central vertigo.

10. Medications and Toxins

Drug Toxicity: Certain medications, such as anticonvulsants, antidepressants, and some antibiotics, can have neurotoxic effects that impair the central nervous system and lead to vertigo.
Alcohol and Drugs: Excessive consumption of alcohol or the use of recreational drugs can affect the brain’s balance centers, resulting in central vertigo.

11. Autoimmune Diseases

Systemic Lupus Erythematosus (SLE): In autoimmune diseases like SLE, inflammation can affect the brain, including areas involved in balance, leading to central vertigo.

12. Chiari Malformation

Brain Structural Abnormalities: Chiari malformation is a condition where brain tissue extends into the spinal canal, affecting the cerebellum and brainstem. This abnormality can lead to central vertigo as well as other neurological symptoms.

13. Metabolic Disorders

Hypoglycemia: Severely low blood sugar levels can affect brain function, potentially leading to central vertigo, especially if the brainstem is involved.
Thyroid Disorders: Severe hypo- or hyperthyroidism can cause neurological symptoms, including central vertigo, although this is less common.

14. Cervical Spine Disorders

Cervical Vertigo: While typically considered peripheral, some cervical spine disorders, particularly those involving the upper cervical spine or its neural connections to the brain, can lead to central vertigo.

15. Inherited Disorders

Spinocerebellar Ataxia: This group of inherited disorders affects the cerebellum and its connections, leading to coordination problems and central vertigo.

Central vertigo is generally more concerning than peripheral vertigo due to the involvement of the central nervous system and the potential for serious underlying conditions. Early and accurate diagnosis is crucial for effective treatment and management.