Benign episodes of positional vertigo – otoliths
Episodes of vertigo when the head position changes: when you get up from bed, raise your head, turn your head or sit on a ladder, the symptoms disappear when you keep a certain position, but the symptoms are not obvious when you walk upright
Duration of each attack: measured in seconds, mostly within 10s
Dizziness during seizure, dizziness or drowsiness when not seized; Li Gang, Department of Neurology, Shenzhen People’s Hospital
Rarely accompanied by nausea and vomiting
The vertigo is easily fatigable and self-improving; it can be recurrent
absence of hearing loss, tinnitus and unsteadiness
No central symptoms; normal hearing examination and temperature test
Migrainous vertigo (migraine equilibrium)
Female:male=4-5:1, age 20-50 years
May have aura (vertigo may be), depending on symptoms
Onset: recurrent episodes of spontaneous vertigo with nausea, sometimes vomiting, photophobia, preference for silence.
Duration: within 1 hour (tens of seconds to several hours), usually improves after rest or sleep (next day).
No or significant headache.
Or history of migraine; shift in migraine form with age.
Psychogenic vertigo or dizziness
”Vertigo” is prolonged, persistent, and unchanging.
It has many concomitant symptoms [somatization symptoms],
It is strongly influenced by external and emotional changes,
The patient is willing to find an objective cause: cervical spondylosis or insufficient blood supply
Willingness to exhaust tests and medications
Mental status assessment should be performed.
TIA or VBI of the vertebral basilar artery, posterior circulation ischemia
Patients tend to have an atherosclerotic etiology, trigeminal hypertension
Onset is often rapid and symptoms are short-lived.