Disorders of Vestibular Function: Or something else? Differential Diagnosis

Eyes and ocular appendages (H00-H59).

  • Visual disturbances (esp. decreased vision) * .

Blood, blood-forming organs – immune system (D50-D90).

  • Anemia (anemia)

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Desiccosis * (dehydration).
  • Hypoglycemia (low blood sugar)
  • Hypokalemia * (potassium deficiency)
  • Hyponatremia * (sodium deficiency)

Cardiovascular system (I00-I99) *

  • Cardiovascular disorders such as hypertension (high blood pressure), hypotension (low blood pressure).
  • Valvular heart disease, unspecified – for example, aortic stenosis (narrowing of the aortic valve): clinical signs: presyncope to syncope (brief loss of consciousness)
  • Cardiac arrhythmias, unspecified
  • Brainstem infarction
  • Cardiomyopathy (heart muscle disease)
  • Myocardial infarction (heart attack)
  • Orthostatic dysregulation – sudden drop in blood pressure after changes in position, especially rapid rising from lying or sitting; clinical signs: presyncope to syncope (brief loss of consciousness).
  • Vertebrobasilar ischemia (decreased blood flow due to decreased blood flow through the vertebral artery and basilar artery) [as DD in cervicogenic vertigo/cervical vertigo].
  • Cerebrovascular disorders (cerebral circulatory disorders).

Infectious and parasitic diseases (A00-B99).

  • Syphilis (lues; venereal disease).
  • Viral and bacterial infections *
  • Viral infections, unspecified (→ neuronitis vestibularis (inflammation of the vestibular nerve leading to disturbance of the vestibular organ with acute vertigo and vomiting) and labyrinthitis (infection of the inner ear, i.e., the cochlea and vestibular organ)).

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoarthritis *
  • Degenerative changes of the musculoskeletal system *
  • Functional disorders of the cervical spine * (→ cervicogenic vertigo/cervical vertigo; video nystagmography: vertical nystagmus (eye tremor with slow movement in one direction followed by faster movement in the opposite direction) during reclination (backward tilt) of the head; vertigo during side tilt of the head).
  • Cervical and lumbar spondylosis (degenerative changes in vertebral bodies)* .

Neoplasms – tumor diseases (C00-D48).

Ears – mastoid process (H60-H95).

  • Acute peripheral vestibulopathy – acute disease of the organ of balance.
  • Cholesteatoma (synonym: pearl tumor) of the ear – ingrowth of multilayered keratinizing squamous epithelium into the middle ear with subsequent chronic purulent inflammation of the middle ear.
  • Dysfunction of the Tuba auditiva (“Eustachian tube”; Eustachian tube).
  • Labyrithitis – inflammation of the labyrinth (arcades in the inner ear), which can lead to balance disorders.
  • Meniere’s disease – disease affecting the inner ear with symptoms of vertigo (dizziness), unilateral tinnitus (ringing in the ears) and sensorineural hearing loss.
  • Otitis media (inflammation of the middle ear), acute and chronic.
  • Perilymph fistula – pathological connections between the individual spaces of the inner ear.
  • Hearing loss *
  • Zoster oticus – special form of herpes zoster (shingles) that affects the ear (inflammation of the ganglion cells of the VII and VIII cranial nerves).

Psyche – nervous system (F00-F99; G00-G99).

  • Agoraphobia – fear of wide places.
  • Alcohol abuse (heavy drinking)
  • Anxiety disorders *
  • Depression *
  • Drug use
  • Epilepsy (falling sickness; seizure disorder)
  • Brainstem lesions
  • Cerebellar diseases *
  • Migraine
  • Parkinson’s disease *
  • Multiple Sclerosis (MS)
  • Myelopathy (spinal cord disease)
  • Panic attack
  • Peripheral neuropathy * – generic term for certain diseases of the peripheral nervous system that affect multiple nerves and lead to nerve damage (e.g. diabetic polyneuropathy).
  • Psychogenic somatoform vertigo: since 2017, has been named internationally as “functional vertigo”; this includes phobic vertigo or “persistent postural-perceptual dizziness”, among others
  • Somatoform disorder (e.g., hyperventilation).
  • Subclavian steal syndrome (synonyms: vertebral tapping syndrome) – this is a so-called tapping syndrome. This refers to a condition in which there is blood withdrawal in a specific area as a result of localized blood flow reversal.
  • TIA (transient ischemic attack) – sudden circulatory disturbance of the brain, which leads to neurological disorders that regress within 24 hours.
  • Vestibular neuritis – inflammation of the nerves belonging to the organ of balance.

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

Injuries, poisoning, and other consequences of external causes (S00-T98).

Medication

Environmental stress – intoxications (poisoning).

  • Alcohol consumption, chronic
  • Drug use
  • Carbon monoxide
  • Carbon tetrachloride
  • Mercury

* Dizziness in elderly patients

Diseases and their typical forms of vertigo

Diseases Vertigo forms
Bilateral vestibulopathy (BV; bilateral damage to the vestibular organ; 17.1%), phobic vertigo (15%) Persistent vertigo
Neuritis vestibularis (8.3%), central brainstem lesion Persistent spinning vertigo
Paroxysmal positional vertigo (most common vestibular vertigo disorder.). Rotational vertigo on head/body position change.
Vestibular paroxysmia (neurovascular compression syndrome of the eighth cranial nerve; 3.7%) Frequent attacks of vertigo of short duration.
Vestibular migraine (dizziness is a partial symptom of migraine in this case; 11.4%), Meniere’s disease (10.1%) Spontaneous, repeated attacks of vertigo