How are central causes of dizziness identified in an evaluation?

Updated: Jun 26, 2018
  • Author: Wayne T Shaia, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Central causes of dizziness can be identified with imaging studies, as follows:

  • Exclude central causes in patients with vertigo. Etiologies such as multiple sclerosis, Wallenberg lateral medullary syndrome, cerebellar ischemia or infarction, benign or malignant CNS or posterior fossa neoplasms, or Arnold-Chiari malformation may cause patients to present with vertigo and signs of vestibular disturbance. The images below depict MRI evidence of these etiologies.

    MRI of a 26-year-old woman with progressive disequ MRI of a 26-year-old woman with progressive disequilibrium and bidirectional horizontal nystagmus shows the periventricular areas of demyelination that are characteristic of multiple sclerosis.
    MRI of a 56-year-old woman with right cerebellar i MRI of a 56-year-old woman with right cerebellar ischemia. Her history included brief episodes of vertigo and a sensation of turning to the right. Her initial MRI was negative. The brief episodes were followed by prolonged episodes of vertigo, nausea and vomiting, and truncal ataxia, which prompted a second MRI study.
    MRI of a 48-year-old woman with progressive unstea MRI of a 48-year-old woman with progressive unsteadiness, projectile vomiting, and headache. She was referred for an evaluation of vertigo. Pathology proved the posterior fossa mass to be a medulloblastoma.
    MRI of a 26-year-old woman with unsteadiness and v MRI of a 26-year-old woman with unsteadiness and vertical nystagmus. Arrow points to an Arnold-Chiari malformation.
  • In almost every case, careful neurologic examination and examination of the peripheral vestibular system reveal either CNS abnormalities or other cranial nerve abnormalities.


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