Table 3 Differential diagnosis of isolated neurological vertigo in childhood

Cephalalgia

  Vestibular migraine

24%

Mainly > 5yo

Vestibular symptoms (rotator vertigo) temporarily with migraine

Time: 5 min or 72 h

Episodic vertigo, age > 5yo, attacks lasting minutes to hours, association at least in some cases with migraine headache or migrainous phenomena

Physical exam and vestibular tests

Lanzi et al. 1994 [12],

D’Agostino et al. 1997 [1],

Russell et al., 1999

Langhagen T et al. 2013 [14],

Raucci et al. 2015 [7]

  Benign Paroxysmal vertigo of childhood

14 to 18%

Mainly < 5yo

F > M

Episodic syndrome with short, non-epileptic, recurrent attacks of subjective or objective vertigo, which resolve spontaneously

Episodic vertigo, age < 5yo, attacks lasting seconds to minutes (to hours) without migraine headache

Clinical exam and instrumental investigations (absence of hearing impairment)

D’Agostino et al. 1997 [1],

Russell et al., 1999 [19]

Langhagen T et al. 2013 [14],

Raucci et al. 2015 [7]

Brain tumour and/or malformation

  Expansive endocranial pathologies and/or malformation

Rare

Vertigo, neurological symptoms, haedache

Association with additional neurologic deficits but neuroimaging is essential

Clinical exam and neuroimaging

D’Agostino et al., 1997 [1]

Caldarelli

M. et al., 2007 [16]

Raucci et al., 2015 [7]

Vascular diseases

  Neurovascular diseases

Rare

Vertigo, neurological symptoms, sincope

Association with additional neurologic deficits but neuroimaging is essential

Clinical exam and neuroimaging

Kalashnikova et al.,2005 [17]

Raucci et al., 2015 [7]

Demyelinating diseases

  Demyelinating diseases

Rare

Vertigo, multidirectional nystagmus

Association with additional neurologic deficits but neuroimaging is essential

Vestibular tests, MRI

D’Agostino et al. 1997 [1],

Raucci et al. 2015 [7],

Salman M. et al., 2017 [13]

Inflammatory disease

  Vestibular neuritis

16%

Mainly > 5yo and adolescents

Sudden onset of severe vertigo, sometimes associated with nausea and vomiting

Vertigo can be intensified by small changes in head position

Electronystagmography, thermal caloric testing

D’Agostino et al., 1997 [1]

Raucci et al., 2015 [7]

Others

  Somatoform vertigo

2.5 to 16%

Mainly adolescent girls

Vertigo organically not sufficiently explained

Normal findings on physical exam and diagnostic evaluation

Psychiatric consultation

D’Agostino et al., 1997 [1]

Raucci et al., 2015 [7]

  Head and/or cervical trauma

7–10% of pediatric giddiness

Isolated vertigo or vertigo associated with hearing loss or others symptoms

History of previous trauma

Imaging of head/cervical chord

Raucci et al., 2015 [7]

  Orthostatic hypotension

3–9% of pediatric giddiness

Isolated vertigo or associated with autonomic symptoms, including syncope

Sudden drop in blood pressure after change in positioning

Blood pressure measurement, tilt test

Raucci et al., 2015 [7]

  Vestibular paroxysmia

4% of pediatric giddiness

Frequent episodes of vertigo, several times in a day, lasting for seconds to minutes, regardless of posture

Good response to carbamazepine or oxcarbazepine

Neuroimaging

Lehnen N et al., 2015 [20]

  Iatrogenic form

Rare

Rarely cause of isolated vertigo

History of drug use or abuse

None/Urine analysis/toxicology screening

D’Agostino et al., 1997 [1]

  Tuberous Sclerosis

Only report

Only one case described child with episodes of vertigo and headache

Presence of amartomas

Cranial MRI/abdomen ultrasound

Ramantani. et al. 2009 [15]

  Familial episodic ataxia type II

Rare

Stress or exercise-induced vertigo and ataxia

Carbonic anhydrase inhibitor, such as acetazolamide, produces a complete response to vertigo

Brain MRI

K. Mugundhan, 2011 [21]

  Anisometropia and other ocular abnormalities

Rare

Sensory mismatch

Resolution with ophthalmological treatment

Ophthalmological examination

Bucci M.P. et al., 2004 [18]