Basic Science and Pathophysiology

The control of balance and awareness of oneself in space is a highly complex process requiring input from, and integration of, sensory information from the eye, joints and the vestibular apparatus of the inner ear (Figs 1-3).

This information is integrated and processed by neurological pathways and connections involving cranial and peripheral nerves, the brain stem and higher brain centres.

Disorders in any of the sensory or integrating components can result in symptoms of dizziness or vertigo, but the disorders can be divided into:

  • Central causes (vestibular nucleus and above)
  • Peripheral causes

Peripheral causes are the more common of the two.

Learning Bite 

Peripheral causes account for about 80% of all vertigo cases.

1. Semicircular canals of the inner ear are sensitive to rotation in three planes – saggital, coronal, axial
1. Semicircular canals of the inner ear are sensitive to rotation in three planes – saggital, coronal, axial
Visual cues provide orientation
2. Visual cues provide orientation
Proprioception from the joints
3. Proprioception from the joints gives an indication of orientation relative to the ground
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Vertigo common presentation to ED department,
occasionally becomes tricky to figure out especially if the cause,
central or cerebellum related and the need for MRI which is a challenge to organise

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