Vertigo Related to Central Nervous System Disorders

Kamala Saha, MD Neuro-otology p. 447-467 April 2021, Vol.27, No.2 doi: 10.1212/CON.0000000000000933
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PURPOSE OF REVIEW This article provides an overview of the numerous causes of vertigo and dizziness that are due to central nervous system (CNS) pathology and guides clinicians in formulating a differential diagnosis and treating patients with CNS causes of vertigo.

RECENT FINDINGS Specific autoimmune vestibulocerebellar syndromes may now be tested for, and this article discusses the antibodies known to cause such syndromes. Superficial siderosis can be more accurately diagnosed with imaging studies, and treatment using iron chelation has recently been studied but has not yet been established as an effective treatment. Central autonomic network damage in the brain can cause central orthostatic hypotension in some neurodegenerative diseases, and medication has been approved for treatment.

SUMMARY CNS causes of vertigo are numerous and important for clinicians to recognize. Examination findings are still an extremely valuable way to diagnose central vertigo; therefore, learning how to differentiate central from peripheral vertigo based on examination is an important skill. CNS causes of vertigo often have available treatments.

Address correspondence to Dr Kamala Saha, 240 W Thomas Rd, Ste 301, Phoenix, AZ 85013, [email protected].

RELATIONSHIP DISCLOSURE: Dr Saha reports no disclosure.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Saha discusses the unlabeled/investigational use of acetazolamide and 4-aminopyridine for the treatment of episodic ataxia type 2, deferiprone as an iron chelator in the treatment of superficial siderosis, and 4-aminopyridine for the treatment of vertical nystagmus and central positional nystagmus.

© 2021 American Academy of Neurology.