Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes

Dizziness is a common complaint among patients seen by primary care physicians, neurologists, and otolaryngologists. The most common causes of dizziness are peripheral vestibular disorders, but central nervous system disorders must be excluded. This article provides an overview of the epidemiology of dizziness, differentiating between central and peripheral vertigo, and central causes of dizziness.

Dizziness is among the most common complaints in medicine, affecting approximately 20% to 30% of persons in the general population. Dizziness is a general term for a sense of disequilibrium. Vertigo is a subtype of dizziness, defined as an illusion of movement caused by asymmetric involvement of the vestibular system. Central vestibular lesions affecting the pons, medulla, or cerebellum cause vertigo, nausea, vomiting, severe ataxia, multidirectional nystagmus that is not suppressed by optic fixation, and other neurologic signs. The other types of dizziness are dysequilibrium without vertigo, presyncope, and psychophysiologic dizziness, which is often associated with anxiety, depression, and panic disorder.

Epidemiologic studies indicate that central causes are responsible for almost one-fourth of the dizziness experience by patients. The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo. The most common central causes of dizziness and vertigo are cerebrovascular disorders related to the vertebrobasilar circulation, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, some drugs, and psychiatric disorders.