Evaluation of dizziness in children and adolescents
- Theresa Walls, MD, MPH
Theresa Walls, MD, MPH
- Assistant Professor of Pediatrics
- George Washington University School of Medicine
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Section Editors
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss the evaluation of dizziness in pediatric patients.
The evaluation and causes of syncope in children and adolescents are discussed separately. (See "Emergent evaluation of syncope in children and adolescents" and "Causes of syncope in children and adolescents".)
Although a common pediatric complaint in ambulatory settings, dizziness is a vague term that can describe many conditions, including lightheadedness (presyncope), anxiety, intoxication, ataxia, visual disturbance, hyperventilation, weakness, depression, and true vertigo. Young children may not be able to describe their symptoms well, making their evaluation challenging. However, a thorough history and physical examination can establish a diagnosis in most cases.
Dizziness describes a disturbed sense of relationship to space . True vertigo refers to the perception that the patient is rotating relative to the environment (subjective vertigo) or that the environment is rotating relative to the patient (objective vertigo) . It results from a disturbance somewhere in the vestibular system, which has both peripheral and central nervous system components. Pseudovertigo describes complaints of dizziness without any rotary component.
The semicircular canals and vestibule (together known as the labyrinth) make up the peripheral vestibular system and are located within the inner ear, adjacent to the cochlea in the petrous portion of the temporal bone (figure 1). These organs send impulses to the central components of the vestibular system, located in the brainstem, cerebellum, and cortex, via the eighth cranial nerve (figure 2). Efferent impulses travel through the vestibulospinal tract to the peripheral muscles and also within the medial longitudinal fasciculus to cranial nerves III, IV, and VI. A disturbance anywhere in the vestibular system may cause patients to have vertigo and associated signs and symptoms such as hearing loss, perceptual changes in vision (eg, blurry vision), and nystagmus.
- Dizziness. In: Dorland's Medical Dictionary, 29th, WB Saunders, Philadelphia 2000. p.538.
- Teach SJ. Dizziness. In: Textbook of Pediatric Emergency Medicine, 6th, Fleisher GR, Ludwig SL, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.226.
- Bower CM, Cotton RT. The spectrum of vertigo in children. Arch Otolaryngol Head Neck Surg 1995; 121:911.
- Choung YH, Park K, Moon SK, et al. Various causes and clinical characteristics in vertigo in children with normal eardrums. Int J Pediatr Otorhinolaryngol 2003; 67:889.
- Ravid S, Bienkowski R, Eviatar L. A simplified diagnostic approach to dizziness in children. Pediatr Neurol 2003; 29:317.
- Riina N, Ilmari P, Kentala E. Vertigo and imbalance in children: a retrospective study in a Helsinki University otorhinolaryngology clinic. Arch Otolaryngol Head Neck Surg 2005; 131:996.
- Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, et al. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol 2014; 78:718.
- Raucci U, Vanacore N, Paolino MC, et al. Vertigo/dizziness in pediatric emergency department: Five years' experience. Cephalalgia 2016; 36:593.
- Casselbrant ML, Mandel EM. Balance disorders in children. Neurol Clin 2005; 23:807.
- Saka N, Imai T, Seo T, et al. Analysis of benign paroxysmal positional nystagmus in children. Int J Pediatr Otorhinolaryngol 2013; 77:233.
- Tusa RJ, Saada AA Jr, Niparko JK. Dizziness in childhood. J Child Neurol 1994; 9:261.
- DIFFERENTIAL DIAGNOSIS
- Life-threatening conditions
- - Head trauma
- - Central nervous system infection
- - Intracranial tumor or abscess
- - Stroke
- - Drug overdose and other poisons
- Common conditions
- - Otitis media
- - Migraine syndromes
- - Benign paroxysmal vertigo of childhood (BPVC)
- - Adverse effects of medications
- - Motion sickness
- - Paroxysmal torticollis of infancy
- - Pseudovertigo
- Other conditions
- - Vestibular neuritis
- - Benign paroxysmal positional vertigo
- - Meniere disease
- - Perilymphatic fistula
- - Seizures
- - Ramsay Hunt syndrome
- - Multiple sclerosis
- - Congenital defects
- Physical examination
- - Vital signs
- - Ear examination
- - Nystagmus
- - Other vestibular signs
- - Neurologic examination
- Ancillary studies