Tinnitus, vertigo and balance disorders in children: Viva

Branch 1: Classifying the vertigo

The candidate should confirm that the first step in a child with dizziness is to establish the quality and the duration of the symptom, because the duration sorts the common benign causes from the dangerous ones. Brief, stereotyped, recurrent episodes lasting seconds to minutes point to the periodic syndromes of childhood, and this girl has the picture of benign paroxysmal vertigo of childhood, the commonest vertigo of a preschool child. A single prolonged attack points to the acute vestibular syndrome, and a constant progressive unsteadiness points to a chronic vestibular hypofunction or a central lesion. The teaching point is that the tempo frames the whole differential before a single test is ordered. ^{[2] [3]}

A strong candidate names the peripheral-versus-central split as the second, recurring cut, applied throughout the assessment, because the central causes are the ones that harm the child if missed. The candidate should explain that benign paroxysmal vertigo of childhood is an episodic syndrome that may be associated with migraine, that the family history of migraine supports it, and that a substantial proportion of affected children develop migraine or vestibular migraine later in childhood. ^[2]