Neurological vertigo in the emergency room in pediatric and adult age: systematic literature review and proposal for a diagnostic algorithm

Abstract

Neurological vertigo is a common symptom in children and adults presenting to the emergency department (ED) and its evaluation may be challenging, requiring often the intervention of different medical specialties. When vertigo is associated with other specific symptoms or signs, a differential diagnosis may be easier. Conversely, if the patient exhibits isolated vertigo, the diagnostic approach becomes complex and only through a detailed history, a complete physical examination and specific tests the clinician can reach the correct diagnosis. Approach to vertigo in ED is considerably different in children and adults due to the differences in incidence and prevalence of the various causes. The aim of this systematic review is to describe the etiopathologies of neurological vertigo in childhood and adulthood, highlighting the characteristics and the investigations that may lead clinicians to a proper diagnosis. Finally, this review aims to develop an algorithm that could represent a valid diagnostic support for emergency physicians in approaching patients with isolated vertigo, both in pediatric and adult age.

Vertigo During Pregnancy: A Narrative Review of the Etiology, Pathophysiology, and Treatment

“…These symptoms are momentary and completely disappear following delivery. Women who have MD during pregnancy often have episodic vertigo, variable sensorineural hearing loss, and roaring or hissing tinnitus [ 34 ].…”

Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology

“…Nevertheless, it is a common reason for emergency department presentation, both alone or associated with other symptoms. Pellegrino et al [174] reported on the etiopathology of neurological vertigo in childhood and adulthood, highlighting the characteristics which may lead clinicians to a proper diagnosis, and proposed a diagnostic algorithm to support the approach to patients with isolated vertigo, both in pediatric and adult age. The most common cause of isolated vertigo in the pediatric population is vestibular migraine, followed by benign paroxysmal vertigo in childhood.…”

Vrtoglavice u djece

“…Također, mo guća je i pojava nistagmusa. 6 Dok epizode periferne vrtoglavice imaju tendenciju brzog prestanka, central na vrtoglavica često dolazi bez upozorenja i može tra jati dugo. Epizode su općenito mnogo intenzivnije od perifernih i često bolesnik ne može hodati i stajati bez pomoći.…”

“…Moždani udar, infekcija SŽSa ili trauma mogu uzrokovati ne samo akutnu ili subakutnu vrtoglavicu, već i dizartriju (nejasan govor), ataksiju (probleme s kretanjem), slabost i obamrlost/ trnce. 6 Centralna je etiologija najčešća u gotovo 70% uzroka vrtoglavice.…”

“…U smislu fizikalnog pregleda obvezno je procijeniti prisutnost nistagmusa koji može biti horizontalan, is crpljujući, inhibiran fiksacijom i pogoršan tresenjem glave u perifernim oštećenjima, dok je obično okomit ili rotatoran u centralnim oštećenjima. 6,11 Epileptički napadi, ponajprije iz parijetalnog režnja, mogu biti praćeni vrtoglavicom; mogu biti vrlo kratkotrajni -do 15 sekundi ili u serijama kratkih epizoda (tablica 1).…”