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Evaluation of dizziness in children and adolescents

Authors
Theresa Walls, MD, MPH
Stephen J Teach, MD, MPH
Section Editors
Douglas R Nordli, Jr, MD
Gary R Fleisher, MD
Glenn C Isaacson, MD, FAAP
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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".)

BACKGROUND

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.

DEFINITION

Dizziness describes a disturbed sense of relationship to space [1]. 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) [2]. 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.

                                   

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Literature review current through: Apr 2017. | This topic last updated: May 26, 2015.
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