Central Vertigo

Central vertigo can clinically manifest in three ways: Acute onset of vertigo and dizziness, recurrent attacks and chronic central vertigo. In patients with acute onset of symptoms it is essential to differentiate between central and peripheral vertigo because this has major diagnostic and therapeutic implications. A differentiation can most often be achieved by a careful neuroophthalmological and neuro-otological bedside examination. One should look in particular for the following five signs of central lesions: skew deviation/vertical divergence (as a component of the ocular tilt reaction), gaze-evoked nystagmus contralateral to a spontaneous nystagmus, saccadic smooth pursuit, acute nystagmus in combination with a nonpathological head-impulse test and central fixation nystagmus. The most frequent forms of central vertigo with recurrent attacks are vestibular migraine and episodic ataxia type 2. Clinically relevant types of chronic or chronic progressive central vertigo are neurodegenerative disorders affecting the cerebellum which are often associated with cerebellar ocular motor dysfunction, in particular downbeat nystagmus. Treatments of choice for a prophylactic therapy of vestibular migraine are betablocker, topiramate or valproic acid. A new treatment option for episodic ataxia type 2 and downbeat nystagmus are aminopyridines (potassium channel blockers). How to cite this article Strupp M, Brandt T. Central Vertigo. Otorhinolaryngol Clin Int J 2012;4(2):71-76.