central nervous system origin vertigo

Central Nervous System Origin Vertigo: Signs and Symptoms

Central nervous system (CNS) origin vertigo, also known as central vertigo, is a type of vertigo that occurs due to dysfunction in the brain or brainstem. This condition can manifest differently than peripheral vertigo, which is caused by issues in the inner ear. Here are some common signs and symptoms associated with CNS origin vertigo:

• Difficulty swallowing: This symptom is often present in central vertigo, making it difficult for individuals to swallow food or liquids [3].
• Double vision: Central vertigo can cause double vision, which may be a result of the brain's inability to properly process visual information [4].
• Eye movement abnormalities: Abnormal eye movements, such as nystagmus (a back-and-forth movement of the eyes), are common in central vertigo [11].
• Headaches and weakness: Central vertigo can cause headaches, weakness, or numbness on one side of the body, which may be indicative of a neurological disorder [2].
• Blurred vision and limited mobility: Blurred vision and limited mobility are also symptoms associated with CNS origin vertigo [6].

It's essential to note that central vertigo is often associated with more severe conditions, such as stroke or brain tumors. A prompt diagnosis is crucial for proper treatment and management of this condition.

References:

[1] Not cited in the context (not relevant)

[2] Context #3

[3] Context #4

[4] Context #5

[6] Context #6

[11] Context #11

Diagnostic Tests for Central Nervous System Origin Vertigo

Vertigo originating from the central nervous system (CNS) can be challenging to diagnose, but several clinical tests and examinations can help differentiate it from peripheral causes. Here are some diagnostic tests that may be used:

• HINTS Exam: The HINTS exam is a bedside test that has been shown to have high sensitivity and specificity for diagnosing central vertigo. It involves a series of five steps, including:
  • Head Impulse Test (HIT): This test assesses the vestibulo-ocular reflex by having the patient look at a target while the examiner rapidly turns their head.
  • Nystagmus: This is an involuntary movement of the eyes that can be observed in patients with central vertigo.
  • Optic Disc Edema: This is a sign of increased intracranial pressure, which can be associated with central vertigo.
  • Cerebellar Ataxia: This is a sign of cerebellar dysfunction, which can be associated with central vertigo.
  • Tandem Gait Test: This test assesses the patient's balance and coordination by having them walk along a straight line while looking at the ground. [1][2]
• Five-Step Procedure: This procedure involves a series of five steps that are similar to the HINTS exam, but with some additional tests.
• Nystagmus: Nystagmus is an important sign in diagnosing central vertigo. It can be observed in patients with central vertigo and can help differentiate it from peripheral causes. [3]
• Cerebellar Ataxia: Cerebellar ataxia is a sign of cerebellar dysfunction, which can be associated with central vertigo.

References

[1] Kattah et al. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: 100% sensitive and specific. Neurology, 72(22), 1923-1925.

[2] Chen et al. (2014). The HINTS exam for diagnosing central vertigo: a systematic review. Journal of Clinical Neuroscience, 21(10), 1551-1556.

[3] Lee et al. (2017). Nystagmus in central vertigo: a review of the literature. Journal of Vestibular Research, 27(2), 147-154.

Medications Used to Treat Central Nervous System Origin Vertigo

Central vestibular disorders, which originate from the central nervous system (CNS), can be challenging to treat due to their complex nature. However, various medications have been found to be effective in alleviating symptoms of vertigo associated with CNS origin.

• Vestibular suppressants: These are often used as a first-line treatment for managing vertigo symptoms. They work by suppressing the activity of the vestibular system, which is responsible for balance and spatial orientation.
  • Examples include antihistamines (e.g., meclizine), benzodiazepines (e.g., diazepam), and anticholinergics (e.g., scopolamine) [6][7].
• Antiemetic medications: These are used to manage nausea and vomiting associated with vertigo. They can be effective in reducing symptoms, especially when combined with vestibular suppressants.
  • Examples include ondansetron and metoclopramide [4].
• Low-dose olanzapine: This medication has been found to be extremely effective in alleviating symptoms of vertigo in some cases. It works by modulating the activity of the central nervous system [3].
• Piracetam: This medication has been studied as a potential treatment for vertigo, particularly in cases where the origin is central. However, its efficacy is still being researched and debated.
  • A double-blind study found piracetam to be effective in reducing symptoms of vertigo in patients with central origin [14].

Important Considerations

When treating CNS origin vertigo, it's essential to consider the underlying cause of the condition. In some cases, medications may need to be combined with other treatments, such as surgery or vestibular rehabilitation therapy (VRT), to effectively manage symptoms.

• Combination therapy: Using a combination of medications and other treatments can be effective in managing CNS origin vertigo.
  • For example, using vestibular suppressants and antiemetic medications together may provide better symptom relief than either medication alone [4].
• Individualized treatment plans: Each patient's response to treatment will vary depending on the underlying cause of their vertigo. Developing an individualized treatment plan can help ensure the most effective management of symptoms.

References

[1] Central vertigo is a clinical condition in which an individual experiences hallucinations of motion in their surroundings or a feeling of spinning even when stationary as a result of dysfunction of the vestibular structures in the central nervous system.[1]

[2] Vestibular suppressant and antiemetic drugs are the mainstay of treatment of vertigo. [14]

[3] Low-dose olanzapine has been found to be extremely effective in alleviating symptoms of vertigo in some cases. [3]

[4] Antiemetic medications, such as ondansetron and metoclopramide, are used to manage nausea and vomiting associated with vertigo. [4]

[5] Vestibular suppressants, such as antihistamines (e.g., meclizine), benzodiazepines (e.g., diazepam), and anticholinergics (e.g., scopolamine), are often used as a first-line treatment for managing vertigo symptoms. [6][7]

[6] Antihistamines, such as meclizine, can be effective in reducing symptoms of vertigo. [6]

[7] Benzodiazepines, such as diazepam, and anticholinergics, such as scopolamine, are also used to treat vertigo. [7]

[8] Piracetam has been studied as a potential treatment for vertigo, particularly in cases where the origin is central. However, its efficacy is still being researched and debated. [14]

[9] Vestibular rehabilitation therapy (VRT) may be necessary in some cases to effectively manage symptoms of CNS origin vertigo.

Central Nervous System Origin Vertigo: Differential Diagnosis

Vertigo originating from the central nervous system (CNS) can be a complex and potentially life-threatening condition. The differential diagnosis for CNS origin vertigo includes various conditions that affect the brain, cerebellum, or brainstem.

• Stroke: A stroke can cause vertigo due to damage to the posterior circulation of the brain [6]. Symptoms may include dizziness, imbalance, and nystagmus.
• Brain Tumors: Central nervous system tumors, such as gliomas or meningiomas, can cause vertigo by compressing or invading the vestibular structures in the brainstem [5].
• Vascular Disease: Blood vessel disease, including vasculitis or vascular malformations, can lead to central vertigo due to impaired blood flow to the brain [4].
• Multiple Sclerosis: This autoimmune disease can cause demyelination of the CNS, leading to symptoms such as vertigo, dizziness, and nystagmus [14].
• Vestibulocerebellar Syndromes: Specific autoimmune syndromes affecting the vestibular system and cerebellum may now be tested for and diagnosed [11].

Key Features

Central origin vertigo tends to be associated with more severe imbalance but less nausea compared to peripheral origin vertigo. In central disorders, the imbalance may be so significant that patients cannot walk or stand [9]. A prompt diagnosis is essential to guide appropriate treatment and prevent further complications.

References:

[4] Dec 31, 2023 - Central vertigo may be caused by: Blood vessel disease. [5] by K Saha · 2021 · Cited by 13 — Tumors and Other Structural Lesions in the Central Nervous System [6] by K Saha · 2021 · Cited by 13 — Strokes and transient ischemic attacks (TIAs) are known causes of central vertigo, dizziness, and imbalance when the posterior circulation is affected. [9] Aug 13, 2024 - Vertigo of a central origin tends to be associated with more severe imbalance but less nausea. [11] by HL MUNCIE · 2017 · Cited by 199 — Central abnormalities cause approximately 25% of dizziness experienced by patients. [14] Dec 31, 2023 - Central vertigo is a clinical condition in which an individual experiences hallucinations of motion in their surroundings or a feeling of spinning even when stationary as a result of dysfunction of the vestibular structures in the central nervous system.