Head and Neck ImagingVertigo
illusion of movement of the patient's body, or of the patient's environment, caused by dysfunction of the equilibrium apparatus. Vertigo should be differentiated from other causes of dizziness, such as
vascular,
cardiac or metabolic disturbances. Vertigo may occur in isolation, or may be associated with
sensorineural hearing loss,
tinnitus, or other symptoms. Vertigo may be caused by peripheral or central causes. The differentiation between peripheral and central causes can usually be made based on clinical history, audiometric, caloric and rotational testing, electronystagmography and other specialized tests.
Examples of peripheral causes are acoustic schwannoma, other tumours of the cerebellopontine angle, congenital anomalies of the inner ear, Mnieres disease, labyrinthitis, labyrinthine fistula caused by cholesteatoma or other aggressive middle ear disease, and labyrinthine trauma. Examples of central causes are multiple sclerosis, ischaemic disease, vascular malformations, intra-axial tumours and infectious and degenerative brain disease.
As a rule of thumb, in patients experiencing vertigo, CT should be used as the first radiological modality if there is clinical evidence of otitis media, or a history of ear surgery is present; in the other patients, MRI may be more informative.
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