Monday, November 11, 2013

Steps for Assessing the Cause of Severe or Persistent Dizziness or Vertigo in Children

Since some causes of severe or persistent dizziness or vertigo in children can be life threatening (for example, a stroke), a physician should first review the patient's history and perform a complete medical exam. Look for impacted ear wax, ear infections, blocked Eustachian tubes, sinus infections, inner ear deformities, hearing loss, traumatic injury, or abnormalities in the responses of cranial nerves III to XII.
If these tests are negative, then the child should be observed for spontaneous nystagmus, gaze nystagmus, gait abnormalities, or ocular smooth pursuit abnormalities. Next a test of limb coordination should be performed, followed by a Romberg Test (the Sharpened Romberg can be used in older children and adults, having the patient stand heel-to-toe on an inch of foam, and the regular Romberg, standing with both feet together, can be used with younger children). If the Romberg is positive, the Epley Maneuver and Headshake test can be performed. A dynamic visual acuity test and specialized tests like a tympanogram, audiological exam, electronystagmography, electrocochleography, rotary chair response test, brainstem auditory evoked response, vestibular evoked myogenic potentials (VEMP) testing and CT or MRI can also be administered to identify the cause of dizziness or vertigo. Known causes of dizziness and vertigo include:
Benign Paroxysmal Positional Vertigo or BPPV (vertigo caused by crystals in the vestibular canals)
vestibular neuronitis or labyrinthitis (vertigo caused by a viral infection)
Meniere's disease (episodes of vertigo, tinnitis and hearing loss caused by leakage of fluid in the inner ear)
labyrinthine fistula
vascular disorders such as migraine, allergies, diabetes or arteriosclerosis (caused by lowered blood flow to the brain)
cerebrovascular disorders (especially of the vertebrabasilar arteries)
cardiocirculatory diseases
compression of the 8th cranial nerve
vasculitis (showing as rash or hives)
tumors (acoustic neuroma, causing vertigo with unilateral tinnitus and hearing loss)
stroke (vertigo with headache, difficulty walking, diverted gaze)<br> multpile sclerosis (vertigo, eyes have difficulty moving past midline toward the nose)
Ramsay Hunt Syndrome (infection causing vertigo with partial facial paralysis)
neck injury (vertigo after whiplash, arthritis or degenerative spine disease)
head trauma (vertigo after a diffuse axonal injury, bleeding or temporal bone fracture)
posttraumatic encephalopathy (vertigo caused by trauma and endocranial bleeding)
Cogan's Syndrome (vertigo and bilateral sensorineural hearing loss together with ocular inflammation)
hypothyroidism (vertigo with hair loss, fatigue, weight gain and brittle nails)
Vestibular Aqueduct Syndrome (vertigo due to malformation of the vestibular canals, often appears with a conductive hearing loss)
Psychogenic Posttraumatic Vestibular Syndrome (headache, vertigo, irritability, insomnia, attention deficits, weakness)
Lyme Disease or infectious causes (can present as vertigo, difficulty staying warm, inattention, chewing, weight loss, stomach pain, sound sensitivity, tinnitus, headaches, chronic fatigue, mood disturbances, photophobia, numbness or tingling in hands or feet, due to neuroborreliosis or erythema chronicum migran infection)
ototoxic or vestibulotoxic medications (e.g. the aminoglycosides, quinolones, antineoplastics, salicylates, Tea Tree Oil, anticonvulsants, loop diuretics, tranquillizers, anti-hypertensives, diuretics, amiodarone, alcohol, methotrexate, analgesics)
Familiarity with these causes and assessment tools will make the identification of the cause of dizziness or vertigo in children easier.
Dr. Michelle MacAlpine is a cognitive developmental neuroscientist in private practice in Plano, Texas. She has authored three books and has travelled worldwide lecturing on issues related to sensory processing, cognitive development and rehabilitation of developmental disorders.

Article Source: