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Pathophysiology, etiology, and differential diagnosis of vertigo

Joseph M Furman, MD, PhD
Section Editors
Michael J Aminoff, MD, DSc
Daniel G Deschler, MD, FACS
Deputy Editor
Janet L Wilterdink, MD


Vertigo is a symptom of illusory movement. Almost everyone has experienced vertigo as the transient spinning dizziness immediately after turning around rapidly several times. Vertigo can also be a sense of swaying or tilting. Some perceive self-motion whereas others perceive motion of the environment. Vertigo is a symptom, not a diagnosis. It arises because of asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem.

Vertigo is only one type of dizziness. Other disorders that present with dizziness include presyncopal faintness, disequilibrium, and nonspecific or ill-defined light-headedness. The initial approach to the patient who complains of dizziness is to localize the cause of the symptom into one of these broad categories. (See "Approach to the patient with dizziness".)

The pathophysiology, etiology, and differential diagnosis of vertigo will be reviewed here. The clinical approach, diagnosis, and treatment of vertigo are discussed separately. (See "Evaluation of the patient with vertigo" and "Treatment of vertigo".)


The end organs of the vestibular system, the semicircular canals and the otolith organs, sense angular and linear motion, respectively. As a result, a patient's description of a spinning sensation is likely to indicate an abnormality of the semicircular canals or the central nervous system structures that process signals from the semicircular canals. Similarly, an illusory sensation of floating or tilting may indicate an otolith system disorder.

Important to the pathogenesis of vertigo is the fact that there is a vestibular labyrinth on each side of the body. The central nervous system receives signals from both the right and left labyrinths and compares these signals with one another. When the head is still, tonic discharges in both vestibular afferents are exactly balanced. During motion, the right and left labyrinths are alternately excited and inhibited, leading to a left-right difference in eighth nerve activity, which is recognized as motion. The spurious left-right differences that result from an acute unilateral peripheral vestibular disorder are also interpreted by the central nervous system as motion or vertigo.

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Literature review current through: Nov 2017. | This topic last updated: Jul 09, 2017.
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