Retrospective Assessment of Clinical and Laboratory Features in Pediatric Neurology Patients Presenting with Vertigo

It was aimed to retrospectively evaluate the clinical, laboratory, neuroimaging, and electrophysiological characteristics of children presenting with vertigo to a tertiary pediatric neurology outpatient clinic and to assess age-related differences in etiological diagnoses.

Medical records of 272 patients under 18 years of age who presented with vertigo between January 2020 and January 2025 were reviewed. Demographic data, accompanying symptoms, neurological examination findings, laboratory results, electroencephalography (EEG) and magnetic resonance imaging (MRI) reports, consultations, and final diagnoses were collected. Patients were categorized as children (<12 years) or adolescents (≥12 years). Descriptive statistics and appropriate comparative tests were used.

The mean age of patients was 12.73±3.68 years; 67.6% were female. The most common accompanying symptoms were visual blackouts (22.1%), headaches (16.2%), nausea and vomiting (11.4%), and syncope (9.2%). Neurological examination was normal in 97.4% of cases. MRI was performed in 84.6% of cases and showed abnormalities in 21.3%; most abnormalities were non-specific, while 4.8% had clinically relevant lesions. EEG was abnormal in 6.3% of cases. The most frequent diagnoses were orthostatic hypotension (23.5%), vestibular migraine (13.6%), psychogenic vertigo (12.9%), benign paroxysmal vertigo of childhood (BPVC) (8.5%), and epilepsy (6.3%). BPVC and epilepsy were more common among children, whereas orthostatic hypotension and psychogenic vertigo were more common among adolescents. No etiology was identified in 13.6% of patients.

Most pediatric vertigo cases were benign, with clear age-specific diagnostic patterns. MRI and EEG contributed to the diagnosis in selected cases, but were largely nonspecific. Multidisciplinary evaluation, including assessment of orthostatic intolerance, migraine, psychogenic factors, and reversible metabolic causes, is essential for effective management.