Dizziness or vertigo is grouped into 2 main categories: peripheral vestibular disorders and central vestibular disorders. This week I will discuss central vestibular disorders. See previous post for details about peripheral vestibular disorders.
Central balance disorders are caused by dysfunction at the level of the brain. If the vestibular system in each ear is working properly and dizziness is still present, the root of the dizziness could be categorized as a central vestibular disorder; meaning the problem is not the vestibular organs or innervating neural pathways. Central vestibular disorders are commonly caused by lesions in the brainstem, specifically in the vestibular nuclei. Vestibular migraines are also a common cause of central vertigo. Many times, attacks of vertigo are associated with headaches or migraine-like symptoms, however, a headache does not have to be present to have vestibular migraines.
One common trademark of central vestibular dysfunction that can easily distinguish a central cause of dizziness versus a peripheral cause is the direction of nystagmus. Nystagmus is involuntary movement of the eyes in a beating pattern. If nystagmus is beating in a vertical pattern, it is almost always of central origin. Audiologists are key healthcare providers in the correct diagnosis of vestibular disorders. Audiologists provide differential diagnosis tools and interpretations to lead patients to the best possible help they can get for proper treatment or improvements in their dizziness.
Patients who experience vertigo, dizziness, or balance problems should be seen by an audiologist who specializes in the vestibular system. Although audiologists cannot treat all vestibular disorders or diseases that can cause dizziness, they can diagnosis and make proper referrals to specialists who can.