Vertigo and dizziness are one of the common causes of neurological consultation. Although the prevalence of dizziness increases with age, it can be a presenting symptom in the pediatric population due to variety of diseases.
Dizziness or giddiness is a symptom which encompasses a variety of sensations experienced by the children. It includes vertigo, blackout, imbalance of gait, confusion, lightheadedness, whirling, spinning, reeling, rotating, movement of the environment, tilting, falling, pushing, rocking sensation, drunken walking, unsteadiness, swaying, visually induced vertigo, head motion induced dizziness etc.
There are 2 different types of dizziness in children.
First is ‘Vertigo’, which means the child feels the illusory movement of head or surroundings i.e. Spinning of head or environment.
The second type Pseudo-vertigo. Pseudo-vertigo describes complaints of dizziness without any rotary component. It could be ‘Syncopal dizziness’ in which the child feels blackout or lightheaded which may or may not be followed by loss of consciousness. Or it could be ‘Dys-equilibrium dizziness’ in which the child feels imbalance on standing and walking. Or it could be ill-defined dizziness in which its very difficult for the child to describe the symptoms.
Vertigo refers to the perception that the child is rotating relative to the environment or that the environment is rotating relative to the patient. It results from a disturbance somewhere in the balance system, which starts from inner ear and extends in the brain especially the brainstem and small brain.
The causes of Vertigo in children range from trivial reasons to serious underlying disorder. The common causes of Vertigo in children include otitis media, benign paroxysmal vertigo of childhood, or a migraine syndrome as the cause of their vertigo. Following steps might help to decide when to consult the doctor.
- The first step in the timely diagnosis of a child who presents with dizziness is to differentiate true vertigo from pseudovertigo. Patients with pseudovertigo may describe a wide variety of symptoms, but will lack a sense of rotation. The details of the symptoms will often point to a cause of pseudovertigo.
- The second step is to look for following triggers, accompanying symptoms and clues which suggest a specific diagnosis i.e. History of 1) head injury, 2) family history of migraine, 3) whether the symptoms are recurrent or not, 4) Fever 5) Consciousness 6) Any ear discharge 7) Presence of hearing loss.
- The third step is to identify whether the onset of vertigo is sudden or gradual. The sudden onset of symptoms represents different causes than the causes due to gradual onset.
- The forth step is to decide whether the child has any alarming symptoms which warrant urgent consultation and brain scan. Children with vertigo and head trauma, altered consciousness, neurologic findings, or evidence of brain infection need a brain scan and additional evaluation.
- The fifth step is examination of the child by a health care provider. Children with true vertigo often display some peculiar finding in the eyes called nystagmus on physical examination. Hence it is advisable to consult a pediatrician.
The knowledge of above information will help the parents to identify the alarming symptoms, give the right information to healthcare provider helping in the prompt diagnosis and treatment of the cause of the vertigo.
Specialist Neurologist
Aster Speciality Clinic, International City
