Vertigo: Pathology review

00:00 / 00:00



Vertigo: Pathology review

Eyes, ears, nose, and throat


Vertigo: Pathology review

USMLE® Step 1 questions

0 / 5 complete


USMLE® Step 1 style questions USMLE

of complete

A 30-year-old woman comes to the clinic due to spinning sensation and feeling unstable. This sensation started 1 month ago and since then has gotten gradually worse. She also describes constant fatigue and tingling sensation in both of her upper extremities. She states that several months ago, she went to the emergency department for an episode of intense right eye pain with movement and the loss of color vision; this gradually improved over 2 weeks. Vital signs are within normal limits. Physical examination shows ataxia and nystagmus. A head MRI shows multiple hyperintense periventricular and cerebellar ovoid lesions. Which of the following is the most likely additional finding in this patient?    

Memory Anchors and Partner Content


At the family medicine center, there’s a 55 year old female, named Juliette, who came to visit the doctor because she has had some episodes where she felt like “everything around her was moving”.

These episodes start abruptly and usually last a few hours.

She also complains of ringing in her left ear and feels that she can’t hear very well from that ear.

Her medical history is otherwise insignificant.

Clinical examination reveals horizontal nystagmus.

Next to Juliette, there’s a 70 year old male, named Alasdair, who is brought in by his son because an hour ago he felt that “the room around him was moving” and had difficulty in speaking.

He also complains of “seeing double”.

Alasdair has hyperlipidemia and hypertension.

Clinical examination reveals vertical nystagmus.

Alright, so both Juliette and Alasdair have vertigo.

People with vertigo will often say they get “dizzy,” which is an imprecise term.

What they are experiencing is either vertigo, syncope or presyncope, also known as lightheadedness, or disequilibrium.

The difference is vertigo can be thought of as having an illusion of self-motion, or movement of the surrounding environment; syncope is the feeling of blacking out or fainting; and disequilibrium causes a sensation of being off balance without the sensation of the environment moving.

Vertigo arises when there’s a mismatch between other sensory systems, like sight and proprioception, and the vestibular system.

The vestibular system is made of the vestibular apparatus; including the three semicircular canals, the utricle and saccule, the vestibular nerve, and the vestibular structures in the brainstem and cerebellum.

Vertigo can be broken down into peripheral vertigo, which is due to damage to the vestibular apparatus, or damage to the vestibular nerve, and central vertigo, which is due to damage to the vestibular structures in the brainstem or cerebellum.


Vertigo is defined as an illusion of movement that's either self-movement or movement of the surrounding environment. Vertigo is classified into peripheral and central vertigo. Peripheral vertigo is caused by disorders like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, and an acoustic neuroma. Causes of central vertigo include posterior circulation stroke, brainstem or cerebellar tumors or lesions.

Diagnosis is made based on clinical presentation and the patient's history, but sometimes imaging studies are required to rule out central causes like a posterior circulation stroke. Treatment depends on the underlying causes and may include medications like antiemetics and benzodiazepines, or even surgery.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Dizziness: a diagnostic approach" Am Fam Physician (2010)
  4. "Visual vertigo: symptom assessment, spatial orientation and postural control" Brain (2001)
  5. "Dizziness and Vertigo in the Adolescent" Otolaryngologic Clinics of North America (2011)
  6. "Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus" Journal of Neurology (2011)
  7. "Eyes on Target: What Neurons Must do for the Vestibuloocular Reflex During Linear Motion" Journal of Neurophysiology (2004)
  8. "Acute vertigo" BMJ (2019)

Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.