Vertigo is not so commonly reported in children. It is less frequent in children as compared to adults. (Aust G, 2005) Moreover, since it is a subjective experience, a child may not be unable to explain his/her symptoms. This may cause delays in understanding of his/her symptoms. (Vertigo in children, 1977). The assessment of symptoms in a child presenting with vertigo is difficult as compared to adults. (A., 1992)
Common causes of vertigo reported in children are viral infections, otitis media (OM), vestibular migraine, benign paroxysmal vertigo (BPV), and unilateral vestibular failure following labyrinthitis. OM, BPV and migraine been reported in 50% to 65% of patients. Less commonly reported causes include head trauma, Meniere’s disease, and brain tumours. (Balatsouras DG, 2007 ) (Bower CM, 1995) (K., 2011)
A detailed history is essential to arrive at a diagnosis. Motion sickness is a frequent and relevant problem in children aged 4-10 years old. A history of fainting in an older child might be due to prolonged standing or a sudden change in body posture. Vestibular neuronitis usually follows a few days after an episode of upper respiratory tract infection. There might be history of recurrent attacks of vertigo but no abnormal neurological signs. In epidemic vertigo which is considered to be caused by a viral infection there is a history of acute onset of vertigo accompanied by nausea and vomiting. Hypoglycemia may also present as vertigo. Cerebral palsy may also (a balance disorder not related to vestibular function) present with dizziness. A number of drugs can also cause vertigo. These include but are not limited to antihistamines, salicylates, aminoglycosides, thiazide diuretics, diazepam, clonazepam, and acetazolamide. (Vertigo in children, 1977)
The term vestibular migraine (VM) used for vestibular symptoms that are causally related to migraine. It is a clinical entity. The diagnostic criteria include a current or past-history of migraine with or without aura, vestibular symptoms of moderate to severe intensity lasting for 5 minutes up to 72 hours, at least 5 episodes meeting above criteria. At least half of these episodes are associated with one of migrainous features, aggravated by physical activity and accompanied by photophobia and phonophobia. (Dieterich M, 2016)
Bedside assessment of vestibular function includes head impulses to examine vestibulo-ocular reflex, oculomotor testing, and vestibulo-spinal function tests. Dix-Hallpike maneuver may also be performed. Besides history taking, pure tone audiometry, and tympanometry should also be performed. In select cases EEG, ENG, and brain scanning are also indicated. Benign paroxysmal positional vertigo in children is an uncommon but documented clinical entity. It is diagnosed by positional testing and treated by repositioning maneuvers. (Galluzzi F, 2022)
In conclusion most common causes of pediatric vertigo include vestibular migraine and benign paroxysmal vertigo of childhood, there are numerous etiological factors. (Davitt M, 2020)
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