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Dizziness (Presyncope (Causes (result of a decrease in global cerebral…

- - - - Why it happens?
        
        Attributed to debris (canalithiasis), usually in the posterior semicircular canal, perturbing labyrinthine sensory receptors and resulting in the erroneous perception of angular head acceleration.
      - Vertiginous sensation is brief (10-30 seconds) and is precipitated by abrupt head movement
      - Nausea is a common accompaniment
      - Recurrence rates are high
      - The Epley maneuver, also known as the canalith repositioning procedure, is an effective and safe treatment
      - Pharmacologic therapy
        
        ineffective for cure but, as with other causes of peripheral vertigo, may be used for symptom relief
        
        medications include centrally acting antihistamines (meclizine), vestibular suppressants (benzodiazepines), and antiemetic drugs
        
        recommended that these medications be used only for short periods of time, as more prolonged use may suppress vestibular feedback and central compensation mechanisms
        
        Vestibular rehabilitation therapy, delivered by trained physical or occupational therapists, is effective for patients with peripheral vertigo, especially if referred early
    - - may follow a viral syndrome that has affected the vestibular portion of cranial nerve VIII
      - Symptoms are generally more severe and of longer duration than in BPPV and may take longer to resolve
      - physical examination findings for both BPPV and labyrinthitis are similar; mixed upbeat-torsional nystagmus may occur, but no focal neurologic findings are present.
    - - Vestibular schwannoma (acoustic neuroma)
      - aminoglycoside toxicity
      - Perilymphatic fistula (vertigo and hearing loss with history of straining or trauma)
      - herpes zoster
      - Meniere disease (classic triad of vertigo, hearing loss, tinnitus)
      - migraine
  - - - Vertebrobasilar stroke is usually, but not always, accompanied by dysarthria, dysphagia, diplopia, weakness, or numbness
      - In a systematic review, focal neurologic signs were present in 80% of patients with stroke who presented with dizziness
      - Cerebellar infarct may present with gait or truncal ataxia or with vertigo alone
      - In one study, gait unsteadiness was reported in 55% of patients with central vertigo.
      - In cerebrovascular accidents located in the posterior fossa of brain, predominant symptom is dizziness in up to 70% of these strokes
    - - Brainstem encephalitis
      - Wernicke syndrome
      - Migraine
      - Multiple sclerosis, can present with vertigo, although a history of other relapsing and remitting neurologic abnormalities, including optic neuritis, is usually present.