Pediatric emergency medicine trisk 0544 0544
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eighth nerve. More commonly, a nonspecific upper respiratory tract infection may
precede the illness. Onset is usually acute and can be severe. Nystagmus is
usually present. Patients prefer to lie motionless with their eyes closed. Recovery
is from 1 to 3 weeks. Early use of prednisone may shorten the course.
Migraine
Vertigo may be a prominent feature of classic migraine, or of a migraine
equivalent, in which there is no associated headache (see Chapters 59 Pain:
Headache and 97 Neurologic Emergencies ). Nearly 20% of children with
migraine may have vertiginous symptoms during their aura. Basilar migraine
presents as a throbbing occipital headache following signs and symptoms of
brainstem dysfunction (including vertigo, ataxia, tinnitus, and dysarthria). Vertigo
from migraine equivalent (without pain) is typically seen in patients with a family
history of migraine headache and is associated with other transient neurologic
complaints (e.g., weakness, dysarthria).
TABLE 24.1
CAUSES OF VERTIGO IN CHILDREN
Peripheral causes
Central causes
Ingestions a , b
Temporal bone fracture a , b
Suppurative or serous labyrinthitis b
External ear impaction (especially cerumen)
Ramsay Hunt syndrome (Varicella zoster
infection)
Cholesteatoma b
Perilymphatic fistula b
Vestibular neuronitis
Benign paroxysmal vertigo
Posttraumatic vestibular concussion
Ménière disease b
Tumor a
Meningitis a , b
Encephalitis a
Trauma a
Stroke a , b
Increased intracranial pressure
a Life-threatening
b May
causes of vertigo.
have associated hearing impairment.
a
Multiple sclerosis
Seizure (usually complex
partial)
Migraine
Motion sickness
Paroxysmal torticollis of
infancy
