Central Pathologies Imitating Peripheral Causes of Vertigo.

Abstract

To differentiate central vertigo mimicking peripheral vestibular diseases with proper history taking, examination and imaging to enable early diagnosis and management. This was an Observational Study carried out over two years and targeted patients across all age groups presenting with complaints of vertigo in ENT OPD of hospitals of the Armed Forces. All patients in all age groups for both genders were included, even those who had presented with recurring symptoms having been managed conservatively elsewhere. In the study population of 147, males were 72 and females were 75. The mean age of the study population was 54 years. The mean age for males and females was 56 years and 52 years respectively. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Version 21. Out of 147 cases, 140 cases presented with typical symptoms of acute peripheral unilateral vestibular dysfunction and 7 presented with symptoms typical of peripheral dysfunction but with abnormal HINTS testing, and on further investigation by imaging, were diagnosed to have vertigo due to central pathologies like Cerebral Venous Thrombosis, Cerebello Pontine Angle Tumour, Posterior Circulation Stroke and Vascular Loops. The most common cause of positional vertigo is BPPV. However, clinicians must be aware that positional vertigo due to central lesions may mimic BPPV. In assessing a patient with positional vertigo, a careful clinical assessment without any preconceived notions of availability heuristic or confirmatory bias, is important to be able to identify the rare cases of CPPV. Features that we found most helpful in distinguishing CPPV and BPPV were the presence of additional neurological symptoms (including headache and vomiting) or signs (limb or gait ataxia), and a failed sustained response to repositioning manoeuvres. Furthermore, apogeotropic horizontal nystagmus on supine roll test and isolated positional downbeat nystagmus should also be considered red flags for CPPV.