Nervous System
10-A. Dizziness and Vertigo
Dizziness
Hyperventilation
Anxiety, psychosomatic causes
Hypoxia
Metabolic or endocrine disorder
Anemia
Infection (e.g., septicemia)
Visual disturbances
Incorrect spectacles
Sudden extraocular muscle paresthesia with diplopia
Hypotension (especially orthostatic) (see 2-J)
Hypertension (see 2-D)
Cardiac arrhythmia or collapse (see 2-N)
Peripheral neuropathy (see 10-N)
Myelopathy (e.g., cervical spondyloses)
Concussion or other significant cerebral insult
Aging (presbycusis or presbyastasis)
Syncope of any cause (e.g., aortic stenosis) (see 10-D)
Drugs
True Vertigo
Infection
Labyrinthitis (bacterial, viral, syphilitic)
Chronic otitis media with middle ear fistula
Vestibular neuronitis or neuropathy
Herpes zoster oticus
Vascular disorders
Vertebrobasilar insufficiency or occlusion
Vascular malformations
Labyrinthine or internal auditory artery occlusion or spasm
Migraine
Hemorrhage into labyrinthine system, brainstem, or cerebellum (e.g., secondary to bleeding diathesis, leukemia, hypertension)
Ménière disease
Benign positional vertigo of Bárány
Drugs and toxins
Alcohol
Quinine
Aminoglycoside antibiotics (especially streptomycin, gentamicin)
Salicylates
Benzene
Arsenic
Arsine
Trauma
Temporal bone fracture
Labyrinthine concussion
Postsurgical (inner ear area)
Perilymphatic fistula
Tumor, especially:
Acoustic neuroma
Cholesteatoma
Epidermoid carcinoma
Metastatic carcinoma (especially breast, kidney, lung, stomach)
Glomus body tumor
Other
References
1. Deafness, dizziness, and disorders of equilibrium. See Bibliography, 2.
2. Daroff RB, Carlson MD. Syncope, faintness, dizziness and vertigo. See Bibliography, 1.
10-B. Headache and Facial Pain
Muscle contraction (tension)
Migraine
Cluster (histamine) headache
Idiopathic
Nonmigrainous causes
Effort (physical activity)
Vasomotor rhinitis
Coital
Cough (e.g., Arnold-Chiari syndrome)
Cold stimulus
Fever, infectious (especially influenza, Q-fever)
Hypertension, especially “malignant”
Hypotension
Hypoxia or hypercapnia, or both (e.g., chronic obstructive pulmonary disease, pulmonary infiltrative disease, sleep apnea syndrome, high altitude) (see 11-M)
Anemia
Atypical angina
Postseizure
Post-lumbar puncture
Endocrine causes
Hypoglycemia
Hypothyroidism
Hyperthyroidism
Adrenal insufficiency
Premenstrual syndrome
Polycystic ovary syndrome
Drugs and toxins
Erectile dysfunction agents
Theophylline
Caffeine and caffeine withdrawal
Nitrates
Nitrites (e.g., hot dogs)
Dextroamphetamines
Ephedrine
Oral contraceptives
Monoamine oxidase inhibitors plus catecholamines
Monosodium glutamate (MSG)
Histamine
Steroid, alcohol, and other substance withdrawal
Disulfiram (Antabuse) plus alcohol
Lead
Benzene
Carbon monoxide
Carbon tetrachloride
Insecticides
Dialysis
Intracranial causes
Acute ischemic cerebrovascular disorder
Intracranial hemorrhage
Tumor
Unruptured arteriovenous malformation
Cerebral venous thrombosis
Aneurysm (with or without hemorrhage)
Epi- or subdural hematoma
Encephalitis, brain abscess
Pseudotumor cerebri
Posttraumatic
High or low cerebrospinal fluid (CSF) pressure
Related to intrathecal injections
Pituitary apoplexy or adenoma
Other lesions (e.g., sarcoidosis)
Arnold-Chiari malformation
Meningeal irritation or inflammation
Infection (e.g., bacterial, viral, tuberculous, fungal)
Carcinomatous infiltration
Intrathecal injection
Postsubarachnoid hemorrhage
Vasculitis (e.g., polyarteritis nodosa)
Cranial and neck causes
Cranial bone lesions
Nose (e.g., craniopharyngioma)
Sinuses (trauma, inflammation)
Ears (external, middle, internal)
Eyes (inflammation, trauma, increased intraocular pressure, poor refraction)
Teeth, jaws (infection, trauma, temporomandibular joint malocclusion)
Cervical spine, ligaments, muscles (e.g., trauma, cervical spondylosis, ankylosing spondylitis, tumor)
Temporal arteritis
Psychogenic, psychiatric (e.g., depression)
Systemic diseases
Infectious mononucleosis
Systemic lupus erythematosus
Hashimoto thyroiditis
Inflammatory bowel disease
Acquired immunodeficiency syndrome
(AIDS)-related illnesses
Erythrocyanotic headache
Mastocytosis
Carcinoid tumors
Serotonin secretory tumor
Some pancreatic islet cell tumors
Pheochromocytoma
Facial pain
Trigeminal neuralgia
Raeder paratrigeminal syndrome
Glossopharyngeal neuralgia
Herpes zoster
Tolosa-Hunt syndrome
Temporomandibular joint pain
Migrainous neuralgia
Dental, sinus, or nasal pain
Trochlear pain
Carotidynia
Otalgia, occipital neuralgia
Atypical facial pain
Burning mouth syndrome
Neck-tongue syndrome
Reflex sympathetic dystrophy (RSD)
Superolaryngeal neuralgia
Nervus intermedius neuralgia
Third occipital nerve headache
Idiopathic
References
1. Headache and other craniofacial pains. See Bibliography, 2.
2. Raskin NH. Headache. See Bibliography, 1.
3. Raskin NH, Green MW. Headache. See Bibliography, 3.
10-C. Paresthesias
Peripheral neuropathy (see 10-N), especially associated with:
Diabetes mellitus
Amyloid
Alcoholism
Carcinomatosis
Thiamine deficiency
Paclitaxel and docetaxel
Peripheral nerve entrapment, compression, trauma (e.g., ulnar nerve compression, thoracic duct outlet syndrome, carpal tunnel syndrome) (see 10-O)
Atherosclerotic peripheral vascular disease
Spinal cord disease
Spinal cord or nerve root compression
Multiple sclerosis
Tabes dorsalis
Subacute combined degeneration of spinal cord (pernicious anemia, vitamin B12 deficiency)
Strachan syndrome
Cortical or thalamic lesions
Metabolic disturbance
Hypocalcemia
Respiratory alkalosis
Hemodialysis
References
1. Paresthesias, pain and dysesthesias. See Bibliography, 2.
2. Rowland LP. Diagnosis of pain and paresthesia, p. 29. See Bibliography, 3.
10-D. Syncope
Neurologic or Mechanical Causes, or Both
Mediated by vagal stimulation or autonomic insufficiency, or both
Vasovagal reaction (often associated with strong emotion or pain)
Prolonged recumbency or inactivity
Peripheral neuropathy with autonomic involvement (e.g., diabetes, amyloidosis, tabes dorsalis, Guillain-Barré syndrome) (see 10-N)
Drugs (e.g., nitrates, antihypertensive agents, ganglionic blockers, alcohol)
Carotid sinus syncope
Severe pain
Swallow syncope
Stretch syncope
Bowel stimulation or defecation syncope
Airway stimulation (e.g., suctioning)
Eyeball pressure
Glossopharyngeal neuralgia
Syringomyelia
Shy-Drager syndrome
Sympathectomy
Primary autonomic insufficiency
Parkinson disease
Seizure
Head or spinal cord trauma
Reduced venous return to heart
Hypovolemia
Hypotension (especially orthostatic) (see 2-J)
Valsalva maneuver
Cough
Voluntary forced expiration against closed glottis
Weight lifting
Micturition
Cardiopulmonary Causes
Cardiac arrhythmias (see 2-N)
Bradyarrhythmias (e.g., sick sinus syndrome)
Tachyarrhythmias (especially ventricular fibrillation, ventricular tachycardia, paroxysmal atrial tachycardia)
Atrioventricular block
Pulmonary embolism (submassive or massive)
Myocardial infarction with cardiogenic shock
Pericardial tamponade
Aortic stenosis
Pulmonic stenosis
Primary pulmonary hypertension
Congenital heart disease
Cardiomyopathies (see 2-G)
Shock (see 2-J)
Atrial myxoma or thrombus
Prosthetic valve thrombosis or obstruction
Cerebrovascular Causes (see 10-L)
Atherosclerotic disease of carotid and/or cerebral vessels (especially vertebral-basilar insufficiency)
Subclavian steal
Takayasu or other arteritis
Hypertensive encephalopathy
Cervical spine abnormalities (e.g., cervical spondylosis)
Intracerebral or subarachnoid hemorrhage
Metabolic Causes
Anemia
Hypoxia
Hyperventilation
Hypoglycemia
Adrenal insufficiency
Heat stroke
Other severe metabolic derangements
Psychological Causes
Anxiety, hysteria
Unknown
References
1. Hirsch L J, Ziegler DK, Pedley TA. Syncope, seizures and their mimics, p. 13. See Bibliography, 3.
2. Faintness and syncope. See Bibliography, 2.
10-E. Deafness
Sensorineural (Inner Ear)
Aging (presbycusis)
Prolonged exposure to loud noise
Drugs
Salicylates
Aminoglycoside antibiotics (especially neomycin, amikacin)
Erythromycin (intravenous)
Furosemide
Quinine
Cisplatin, carboplatin
Vancomycin (intravenous)
Infection
Meningitis
Chronic middle or inner ear infection
Labyrinthitis
Bacterial
Viral (e.g., mumps)
Syphilis (usually congenital)
Herpes zoster oticus
Measles vaccination
Scarlet fever
Mycoplasma pneumoniae infection
Autoimmune disease (e.g., polyarteritis nodosa, Cogan syndrome)
Ménière disease
Fractures of temporal bone
Cochlear otosclerosis
Tumor or infection of eighth nerve or cerebellopontine angle
Acoustic neuroma
Cholesteatoma
Lymphoma
Carcinoma
Eighth nerve infarction
Multiple sclerosis
Sarcoidosis
Meningeal hemosiderosis
Vogt-Koyanagi-Harada disease
Postoperative [e.g., post-coronary artery bypass graft (CABG)]
Hereditary or congenital causes (e.g., congenital rubella, Alport syndrome)
Any central auditory pathway lesion (e.g., small strokes, multiple sclerosis)
Conductive
Cerumen impaction and foreign bodies
Otosclerosis
Eustachian tube obstruction
Chronic otitis media, cholesteatoma
Trauma (including temporal bone fracture, bleeding into middle ear)
Mucopolysaccharidoses
Neoplasm
Central (e.g., temporal lobe disease)
Hysterical
References
1. Deafness, dizziness, and disorders of equilibrium. See Bibliography, 2.
2. Storper IS. Dizziness and hearing loss, p. 32. See Bibliography, 3.
10-F. Ataxia
Symmetric and Progressive Cerebellar Signs
Acute (hours to days)
Toxic
Paclitaxel, docetaxel
Alcohol
Fluorouracil
Lithium
Phenytoin
Barbiturates
Carbamazepine
Heatstroke
Viral cerebellitis
Seizure disorder
Postinfection syndrome
Hypoglycemia
Hyponatremia
Hypoxic encephalopathy
Cranial trauma
Subacute (days to weeks)
Toxic
Arsenic-bismuth
Mercury
Lead
Glue and paint sniffing
Toluene exposure
Spray painting
Chemotherapeutics
Thallium
Organophosphates
Alcoholic nutritional (e.g., vitamin B1 and B12 deficiency)
Lyme disease
Miscellaneous infections (e.g., viral, toxoplasmosis)
Chronic (months to years)
Focal and Ipsilateral Cerebellar Signs
Acute (hours to days)
Cerebellar hemorrhage
Thrombosis or embolism
Epi- or subdural hematoma
Infarction
Vasculitis
Cerebellar abscess
Subacute (days to weeks)
Acute multiple sclerosis
Primary or metastatic neoplasm
AIDS-related progressive multifocal leukoencephalopathy or lymphoma
Chronic (months to years)
Stable gliosis due to stroke or demyelinating plaque
Dandy-Walker or Arnold-Chiari malformations
