Vertigo and disequilibrium during early childhood
Hideaki Sakata, Kimitaka Kaga. Japan
Childhood vertigo and disequilibrium are overlooked in many cases because children rarely complain of them. Childhood diseases and conditions differ among neonates, infants, and schoolchildren. Examination procedures are not similar to those for adults. In clinical practice, many children are brought to the Department of Pediatrics (Neurology) or the Department of Orthopedics with delayed gait, muscle hypotonia or frequent falling-down.
In this symposium, we review the diagnosis and pathogenesis of vertigo/disequilibrium during early childhood, focusing on rare diseases such as benign paroxysmal torticollis.
Childhood vertigo is classified into 2 types: vertigo that children complain of (sensory disturbance) and disequilibrium-related balance abnormalities (motor control disturbance). Children aged 4 to 5 years can complain of vertigo. Rotatory vertigo is frequent. Younger children rarely complain of it. In those aged 2 to 3 years, their mothers become aware of gait disorder, frequent falling-down, or muscle hypotonia.
As information obtained from asking children questions are limited, it is also necessary to interview their mothers and evaluate the motor development process. Concerning balancing dysfunction, as the central nervous system is under development, the peripheral static-sense system, myelination/maturation of the central nervous system, process of functional integration, and learning/acquisition of gross and fine motor skills at each age must be considered.
During early childhood, brain tumors, especially cerebellar/brainstem tumors, cerebellitis, and acute cerebellar ataxia should be considered. In addition, the presence of congenital nystagmus must always be considered.
As a type of vertigo specific to this period, childhood benign paroxysmal vertigo is frequent: rotatory vertigo initially occurs at 1 to 4 years of age, and attacks persisting for a few seconds to minutes repeatedly appear. The tendency to fall down is marked. The mechanism of migraine may be involved. This type of vertigo reflects ischemia of the vestibular nuclei involving the pons to medulla oblongata. In most cases, a spontaneous cure is achieved within a few months to years. For diagnosis, a detailed inquiry is conducted, and children’s parents are requested to record their states during vertigo attacks using a home video camera.
Benign paroxysmal torticollis has been recognized as a type of vertigo resembling migraine. This disease is rare, but many children are first taken to the Department of Orthopedics due to torticollis. Repeated paroxysmal torticollis appears at 1 to 5 years of age, and a tendency to fall down is observed. Ocular displacement and gait disorder are also noted. However, these symptoms resolve with development. This disease may reflect ischemia of the tegmentum mesencephali and Сajal interstitial nucleus, which are adjacent to the uncertainty zone.
The incidence of migraine-related vertigo, including dizziness, is reportedly 50 to 70%. In particular, childhood basilar artery-type migraine is observed in 1- to 10-year-old children. It causes astasia/gait disorder, nausea, vision disorder, occipital pain, and other neurologic symptoms.
For the diagnosis of childhood vertigo/disequilibrium, it is important to conduct careful a follow-up of motor development, select diseases to be considered with respect to age, and understand their characteristics. Although examinations are difficult in many cases, various examinations should be combined, and the features of vertigo/disequilibrium must be analyzed based on the results of a parent inquiry and videotape records of attacks.
Key words: vertigo, children, ENG, MR