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'Cardiogenic vertigo'—true vertigo as the presenting manifestation of primary cardiac disease

Nature Clinical Practice Neurology volume 2, pages 167–172 (2006)Cite this article

Abstract

Background A 90-year-old woman presented to a hospital emergency department with a brief loss of consciousness that was heralded by spinning vertigo lasting approximately 2 min. She had a long history of intermittent brief episodes of rotatory vertigo, presyncope, and non-vertiginous dizziness, occurring either with or without loss of consciousness. Although initially attributed to symptomatic carotid artery stenosis, these episodes persisted, despite surgical restoration of carotid artery blood flow 1 year after her first syncope. Her medical history was otherwise notable for hypertension, mild depression and a gradual decline in gait and balance function attributed to left hip arthritis and older age.

Investigations Bedside history and examination, non-contrast head CT scan, electrocardiogram, transthoracic echocardiogram, and bedside cardiac telemetry.

Diagnosis Sick sinus syndrome or severe reflex bradycardia with asystole causing recurrent, episodic vertigo, presyncope, non-vertiginous dizziness and syncope (Stokes–Adams attacks).

Management Placement of a temporary pacing wire, followed by surgical implantation of a single-chamber ventricular (VVI) pacemaker.

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Acknowledgements

We thank Dr Julie Newman-Toker and Dr David Zee for critically reviewing the manuscript and providing us with valuable editorial advice. The preparation of this manuscript was supported by grants from the Foundation for Education and Research in Neurologic Emergencies (FERNE), and the National Institutes of Health (NIH) (National Center for Research Resources K23 RR17324-01, “Building a New Model for Diagnosis of ED Dizzy Patients”).

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Authors and Affiliations

  1. Assistant Professor of Neurology and Otolaryngology, with joint appointments in Ophthalmology, Epidemiology, and Health Sciences Informatics at Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David E Newman-Toker

  2. Associate Professor of Medicine and Epidemiology at Harvard Medical School, Boston, MA, USA

    Carlos A Camargo Jr

Authors
  1. David E Newman-Toker
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  2. Carlos A Camargo Jr
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Correspondence to David E Newman-Toker.

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The authors declare no competing financial interests.

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Newman-Toker, D., Camargo, C. 'Cardiogenic vertigo'—true vertigo as the presenting manifestation of primary cardiac disease. Nat Rev Neurol 2, 167–172 (2006). https://doi.org/10.1038/ncpneuro0125

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