Table 3.

Differential diagnosis of isolated neurological vertigo in childhood

Differential Diagnosis	Incidence/Prevalence	Main Features	Clues for Differential	Examination Required	References
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]