Central vertigo is vertigo due to a disease originating from the central nervous system (CNS). It often includes lesions of cranial nerve VIII as well. Individuals with vertigo experience hallucinations of motion of their surroundings.Central vertigo may be caused by hemorrhagic or ischemic insults to the cerebellum the vestibular nuclei, and their connections within the brain stem. Other causes include CNS tumors, infection, trauma, and multiple sclerosis.
History of central vertigo
The most comprehensive understandings of a thing usually come from its relation to something else. In the same way, we cannot fully understand light without its relation to dark. We cannot fully understand central vertigo without its relation to specific systems in our body. Because the causes of vertigo stem either from the vestibular system in the inner ear or the central nervous system, they are categorized into peripheral vertigo (vestibular) and central vertigo (the other one).As the central nervous system refers to the brain and the spine, symptoms vary from that of peripheral Vertigo.
Positional vertigo: abrupt onset of vertigo associated with a change in position suggests benign positional vertigo, a form of peripheral vertigo.
Cranial nerve deficits
Symptoms related to derangement of cranial nerves other than the eighth nerve suggest involvement of the brainstem and/or cerebellum.
Facial nerve dysfunction, most commonly manifested as weakness or twitching in the periorbital area, is seen in 10% of patients with acoustic neuroma.
Crossed findings (ie, when the patient has signs on one side of the face and sensory motor signs on the other side of the body) clearly suggest brainstem involvement.
This includes the classic lateral medullary infarction (Wallenberg syndrome) consisting of ipsilateral limb ataxia, Horner syndrome, palatal weakness, facial hypesthesia to pain and temperature, and contralateral hypesthesia to pain and temperature in the limbs and trunk.
Symptoms tend to be more debilitating than those of an underlying inner ear infection. As well as dizziness and nausea associated with peripheral vertigo, symptoms may include an inability to walk, poor vision and slurred speech.
Acute dizziness and vertigo is usually managed with vestibular suppressants, antiviral medication, and antiemetic medications. Steroids are useful in selected patients. Vestibular suppressants should be used for a few days at most because they delay the brain’s natural compensatory mechanism for peripheral vertigo. Vestibular rehabilitation is very useful in boosting central vestibular compensation.
Dizziness is among the most common complaints in medicine, affecting approximately 20% to 30% of persons in the general population. Dizziness is a term for a sense of disequilibrium. Vertigo is a subtype of dizziness, defined as an illusion of movement caused by asymmetric involvement of the vestibular system. Epidemiologic studies claim that central causes are responsible for almost one-fourth of the dizziness experience by patients. The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo. The most common central causes of dizziness and vertigo are cerebrovascular disorders related to the vertebrobasilar circulation, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, some drugs, and psychiatric disorders.