Vertigo due to central lesions

• in central vertigo (1)
  • the vertigo develops gradually. Exception- acute cerebrovascular events (an acute central vertigo is probably vascular in origin)
  • central lesions usually cause neurological symptoms and signs in addition to vertigo
  • auditory features tend to be uncommon.
  • causes severe imbalance
  • nystagmus is purely vertical, horizontal, or torsional and is not inhibited by fixation of eyes onto an object
  • latency following provocative diagnostic maneouver is shorter (up to 5 seconds)
• causes may include:
  • cerebellopontine angle tumor (1)
  • cerebrovascular disease:
    
    • transient ischemic attack
    • stroke
  • vertebro-basilar insufficiency and thromboembolism:
    • lateral medullary syndrome
    • subclavian steal syndrome
    • basilar migraine
  • brain tumour:
    • for example an ependymoma or a metastasis in the fourth ventricle
  • migraine (1)
  • multiple sclerosis (1)
  • aura of epileptic attack - especially, in temporal lobe epilepsy
  • plaque of demyelination in the pons - multiple sclerosis
  • drugs - for example, phenytoin, barbiturates
  • syringobulbia

Reference:

• (1) Ronald H. Labuguen. Initial Evaluation of Vertigo. Am Fam Physician 2006;73:244-51, 254