DIZZINESS AND VERTIGO




























  • References [2,6,7,9]
Peripheral vs Central Vertigo
Feature Comparison
Head impulse test Peripheral
  • Eyes are dragged off object and then rapidly correct in opposite direction
Central
  • Eyes are not dragged off object
Nystagmus Peripheral
  • Nystagmus is horizontal or torsional but never vertical
  • The direction of the fast phase is the same in all gazes
Central
  • Nystagmus may be in any direction
  • Direction of fast phase may change with different gazes
Test of skew Peripheral
  • No vertical shift is noted when the eye is uncovered
Central
  • Vertical shift is noted when the eye is uncovered
Duration Peripheral
  • BPPV causes episodic vertigo that typically lasts < 1 minute, while vestibular neuritis and labyrinthitis cause constant vertigo that is worsened by head movement.
Central
  • Symptoms are typically constant
Triggers Peripheral
  • More likely to be triggered by change in body position or head movement
Central
  • More likely to be spontaneous or persistent without triggering event; although, vertigo may worsen with head movement
Imbalance Peripheral
  • Imbalance is typically mild or moderate and patient can usually walk
Central
  • Imbalance can be severe, and patient may not be able to walk
Ear symptoms Peripheral
  • Ear symptoms including tinnitus and hearing loss are common
Central
  • Ear symptoms are uncommon
Other neurologic deficits Peripheral
  • Uncommon
Central
  • May be present, but < 20% of patients with acute vestibular syndrome and stroke have focal neurological signs








  • Reference [1,9]
Medications associated with dizziness
Antihypertensives
  • Any drug that lowers blood pressure has the potential to cause dizziness. Antihypertensive-induced dizziness often presents as orthostatic hypotension. The drugs listed below are some of the more commonly implicated drugs.

  • Alpha blockers (e.g. tamsulosin, doxazosin)
  • ACE inhibitors (e.g. lisinopril, benazepril)
  • Beta blockers (e.g. atenolol, metoprolol carvedilol)
  • Alpha-2 agonists (e.g. clonidine)
  • Diuretics (e.g. hydrochlorothiazide, furosemide)
  • Vasodilators (e.g. hydralazine, minoxidil)
Central nervous system agents
  • Any drug that exerts its effect in the central nervous system may cause dizziness

  • ADHD medications (e.g. methylphenidate, amphetamine)
  • Alzheimer's medications (e.g. donepezil, memantine)
  • Anticonvulsants (e.g. phenytoin, carba mazepine)
  • Antidepressants (e.g. fluoxetine, paroxetine, amitriptyline)
  • Antiparkinson drugs (e.g. bromocriptine, levodopa, pramipexole)
  • Antipsychotics (e.g. haloperidol, olanzapine)
  • Benzodiazepines (e.g. diazepam, alprazolam)
  • Buspirone (Buspar®)
  • Lithium
  • Insomnia medications (e.g. zolpidem, eszopiclone)
  • Migraine headache medications (e.g. sumatriptan, rizatriptan)
  • Muscle relaxers (e.g. cyclobenzaprine, carisoprodol)
  • Opioids (e.g. hydrocodone, codeine)
Other
  • Aminoglycoside antibiotics (e.g. gentamicin)
  • Antihistamines (e.g. diphenhydramine)
  • Dipyridamole (Aggrenox®)
  • Erectile dysfunction medications (e.g. sildenafil, tadalafil)
  • Flibanserin (Addyi®)
  • Gastrointestinal anticholinergics (e.g. dicyclomine, hyoscyamine)
  • Nitrates (e.g. nitroglycerin)
  • Salicylates (e.g. aspirin, mesalamine)
  • Urinary anticholinergics (e.g. oxybutynin, tolterodine)