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vertigo due to central lesions

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  • in central vertigo (1)
    • the vertigo develops gradually. Exception- acute cerebrovascular events (an acute central vertigo is probably vascular in origin)
    • central lesions usually cause neurological symptoms and signs in addition to vertigo
    • auditory features tend to be uncommon.
    • causes severe imbalance
    • nystagmus is purely vertical, horizontal, or torsional and is not inhibited by fixation of eyes onto an object
    • latency following provocative diagnostic maneouver is shorter (up to 5 seconds)
  • causes may include:
    • cerebellopontine angle tumor (1)
    • cerebrovascular disease:
      • transient ischemic attack
      • stroke
    • vertebro-basilar insufficiency and thromboembolism:
      • lateral medullary syndrome
      • subclavian steal syndrome
      • basilar migraine
    • brain tumour:
      • for example an ependymoma or a metastasis in the fourth ventricle
    • migraine (1)
    • multiple sclerosis (1)
    • aura of epileptic attack - especially, in temporal lobe epilepsy
    • plaque of demyelination in the pons - multiple sclerosis
    • drugs - for example, phenytoin, barbiturates
    • syringobulbia

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