Vascular dizziness

Dizziness is a common symptom that can stem from a range of pathophysiological mechanisms and occurs in many diseases. While dizziness is usually due to benign causes, it can sometimes signal serious, life-threatening illnesses. Focusing on the time course enables symptoms to be categorized into acute vestibular syndrome, episodic vestibular syndrome and chronic vestibular syndrome. Cerebrovascular pathology can be a cause of vestibular dizziness. In this case, transient isolated dizziness is one of the most common precursors of a transient ischemic attack in the vertebrobasilar basin. Ischemic stroke is considered as the most common cause of central acute vestibular syndrome. Strokes manifested by vestibular symptoms frequently occur due to damage to the brainstem or cerebellum, but can also be observed due to damage to the cerebral hemispheres. Cerebral small vessel disease is a significant factor in the development of dizziness in the elderly. Discriminating vascular causes in patients with acute vertigo is challenging, especially when associated neurological symptoms are not evident. In recent years, several bedside diagnostic techniques have been developed to effectively differentiate between peripheral and central vertigo. Diagnostic criteria for vascular vertigo were established and published by the International Barany Society for the classification of vascular vertigo into several types: definite acute prolonged vascular dizziness, probable acute prolonged vascular dizziness, transient and acute dizziness in evolution, as well as probable acute dizziness in evolution and probable transient dizziness. For the treatment of dizziness, pharmacological, physiotherapeutic, psychotherapeutic/behavioural and, less frequently, surgical approaches may be considered. Combination of different methods is often used. The choice of therapy depends on the pathophysiology and etiology of dizziness.

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