Differential diagnosis of vertigo

어지럼증의 감별진단

Vertigo and dizziness are common symptoms with various etiologies and pathogeneses. Vertigo is an illusion of motion due to disease of the vestibular system, usually a sense of rotation. Dizziness, a term that represents a wide range of non-vertigo symptoms, is commonly associated with non-vestibular disorders including old age, cardiac syncope, orthostatic hypotension, metabolic disease, anxiety, and drugs. Vertigo should be determined whether the cause is central or peripheral. Peripheral vertigo is usually benign but central vertigo is serious and often require urgent treatment. The careful history and detailed physical examinations(pattern of nystagmus, ocular tilt reaction, head impulse test and positional tests such as Dix-Hallpike maneuver) provide important clues to the diagnosis of vertigo. Most of patients have benign peripheral vestibular disorders - vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and Meniere's disease. BPPV is a leading cause of peripheral vertigo and can easily be cured with a canalith repositioning maneuver. In this review, a focus is on the differential diagnosis of common vestibular disorders with peripheral and central causes.