The Differential Diagnosis of Vertigo in Children

Abstract

Objectives Vertigo is a relatively common complaint in children with 5.3% of pediatric patients complaining of this symptom. Although the causes of vertigo have been well established in adults, the diagnoses in children have not been well described. The aims of this systematic review are to discover the current information regarding etiologies of vertigo in children and to determine the most common diagnoses that present with vertigo in pediatric patients. Methods PubMed, Scopus, and Embase were searched using the PRISMA guidelines. The inclusion and exclusion criteria were established a priori. All results were analyzed using a Bayesian methodology for point estimation and credible interval calculation. Results From the database searches, 1419 titles were reviewed. Twenty-two studies met inclusion criteria. From these studies, a total of 2726 children aged 2 months to 19 years were reported. The top 4 diagnoses associated with childhood vertigo include vestibular migraine (23.8%; credible interval, 22.3%–25.5%), benign paroxysmal vertigo of childhood (13.7%; credible interval, 12.4%–15%), idiopathic or no identified association (11.7%; credible interval, 10.5%–12.9%), and labyrinthitis/vestibular neuronitis (8.47%, credible interval, 7.46%–9.55%) accounting for approximately 57% of cases. Less common diagnoses included Meniere disease and central nervous system tumors. Conclusions Although the most common causes of pediatric vertigo include vestibular migraine and benign paroxysmal vertigo of childhood, the etiologies are myriad. Rates and credible intervals are provided to permit a probabilistic diagnostic approach to these children.

Benign Positional Paroxysmal Vertigo in Children

“…The posterior semicircular canal is generally involved in about 80% of cases and the lateral semicircular canal in 20% of cases, as in adults. Anterior canal involvement is rare [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 32 , 33 , 34 , 35 , 36 , 38 ].…”

“…In our series, they sometimes describe a “nightmare” sensation if they awake with vertigo at night. The study of eye movements by Frenzel-oculoscopy or by infrared video-oculoscopy is almost the same as that carried out in adults, as are positional and provocative maneuvers for detection of nystagmus [ 13 , 15 , 26 , 27 , 31 , 38 , 43 ]. It is essential to have the child participate during the vestibular evaluation, to attract his attention and avoid excessive concern or lack of cooperation.…”

“…It is associated with familial migraine (according to the diagnostic criteria of the International Headache Society) [ 47 ], and considered as an early migraine equivalent, such as myogenic torticollis and cyclic vomiting. Neurological disorders, although rare representing less than 1% of cases, include gliomas, meningiomas, schwannomas, and brainstem–cerebellar neoplasms [ 13 , 15 , 29 , 38 ]. …”

“…The clinical form was well described by Dix and Hallpike in 1952 [ 2 ] and since then numerous liberatory maneuvers in both adults and children have been proposed for treatment [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The prevalence of BPPV in the pediatric age is lower than in adults [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The lower frequency of BPPV in children is due to less common causes of otoconia detachment than in adults (hypertension, metabolic disorders, atherosclerosis) [ 15 ].…”

Vertigo in Children; Differential Diagnosis

“…Vertiginöz çocuklarda yapılan ENG-VNG kayıtlarında yaklaşık %60 oranında anormallikler tespit edilmiştir (12)(13)(14). Güncel bir derlemede 2726 pediatrik vertigo olgusu değerlendirildiğinde, ayırıcı tanılar içerisinde ilk sırayı %23.8 ile vestibüler migren (VM) alırken, ikinci sırada %13.7 ile BPV ve üçüncü sırada ise %11.7 ile idiopatik veya tanımlanmamış grup gelmektedir (17).…”