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You are evaluating a 5-year-old with symptoms of dizziness. The child has been having episodes of sudden unsteadiness, grabbing onto nearby objects for balance, and nausea/vomiting. When questioned, he does describe “the room spinning,” and exam reveals nystagmus, leading you to suspect vertigo. All of the following would raise suspicion for a central cause of vertigo over the more benign peripheral cause except one…
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June 3, 2026 at 1:54 pm
A) Nausea and vomiting
The most common causes of vertigo in children are ear disease, benign paroxysmal vertigo of childhood, and migraine headache. Vertigo is differentiated from general dizziness by a spinning sensation and nystagmus. Vertigo tends to be acute in onset and often involves nausea and vomiting. Nystagmus that reverses direction, is vertical or torsional rather than horizontal, is not suppressed by visual fixation raises concern for a central vertigo, as does severe postural instability, ataxia, and an abnormal neurologic exam. Benign paroxysmal vertigo of childhood typically occurs in preschoolers as brief episodes of dizziness, nystagmus, and loss of balance. There is commonly a positive family history of migraines. Episode duration is usually less than a minute, although a child may have clusters of episodes. Diagnosis is one of exclusion and is typically made clinically. There is no specific treatment and it usually resolves spontaneously as the child becomes school-aged.