When vertigo occurs due to conditions of the brain it is called central vertigo.
Vertigo can also occur due to conditions of the inner ear or the nerve that connects the inner ear to the brain. This is called peripheral vertigo.
Vertigo of central origin most often occurs due to conditions of the brainstem and cerebellum. It is seldom that vertigo will occur in isolation and it is most often accompanied by other neurological symptoms such as double vision, headache, memory loss, weakness or numbness. It is therefore important that a complete medical history is obtained and comprehensive examination performed so that neurological conditions can be excluded in all patient presenting with vertigo.
Disorders of higher vestibular function are a subtype of central vertigo where the lesion is not in the brainstem or cerebellum but isolated in the higher cortical representation areas of the brain. This often involves other sensory modalities such as the cognitive disturbance of spatial orientation, attention, spatial memory and navigation ability.
Central vertigo is typically characterized by abnormal eye movement, perceptual and postural manifestation. Examination of the eye movements is critically important to distinguish central vertigo from peripheral vertigo.
The main causes for central vertigo include infarctions and strokes, bleeding, tumours, degenerative disease and multiple sclerosis (MS). Often medication can influence the brain, causing vertigo. Deficiency in Vitamin B12 and Magnesium as well as certain toxins can cause vertigo, dizziness and imbalance. Alcohol is a common suppressor of cerebellar function. Structural lesions and conditions include Wallenberg’s syndrome, atrophy of the brain and cerebellum and Arnold Chiari malformation.
It is of vital importance that any patient who presents with vertigo or acute dizziness is properly assessed to rule out a central cause. Although the majority of cases would be due to peripheral conditions, which are temporary, it is important to note that it is the central conditions that may pose a serious risk for permanent incapacity.