Vertigo in children: etiology and clinical characteristics of acute vestibular disorders

Acute vestibular syndrome (AVS) in children is an uncommon but clinically challenging presentation, often requiring rapid differentiation between peripheral and central causes. Evidence focusing specifically on AVS in the pediatric population using standardized vestibular classifications remains limited. The aim of this study was to describe the frequency, etiological distribution, and age-related patterns of acute vestibular syndrome in a large cohort of pediatric patients.

We conducted a retrospective, descriptive, analytical and observational study including patients aged 0-18 years who presented with balance disorders at a single tertiary pediatric hospital between March 2015 and December 2022. Cases were classified according to the Bárány Society criteria into acute, episodic, and chronic vestibular syndromes. Clinical, demographic, and etiological data were analyzed, with a particular focus on AVS.

A total of 723 patients were included. AVS accounted for 18.3% of cases [95%CI: 15.5-21.2]. The most frequent etiologies were acute post-infectious cerebellitis (21.9%), vestibular neuritis (17.4%), and post-traumatic vertigo (15.9%). Overall, central causes were more frequent than peripheral etiologies (56.8% [95%CI: 48.3-65.0] vs. 43.2% [95%CI: 35.0-51.7]). A significant age-dependent shift was observed (χ² = 11.5; p = 0.003): central causes predominated in children aged 0-5 years (73.7% [95%CI: 58.0-85.0]), while peripheral etiologies became more frequent in adolescents aged 12-18 years (63.4% [95%CI: 48.1-76.4]).

AVS in pediatric patients is a heterogeneous entity with a clear age-dependent etiological pattern. Central causes predominated in younger children, whereas peripheral vestibular disorders became increasingly common with age. These findings highlight the importance of an age-tailored diagnostic approach in the evaluation of acute vertigo in children. Although the study population may be subject to selection bias, our findings may still assist clinicians in formulating the differential diagnosis when evaluating pediatric patients with AVS.