Vertigo and dizziness syndromes in children and adolescents: Clinical presentation and diagnostic pathway.

AIM: To provide a broad overview of the diagnostic spectrum of vertigo and dizziness syndromes in children and adolescents, to characterize distinct clinical and instrument-based findings, and to propose a reasonable diagnostic approach for the 'dizzy child', as the underlying causes differ from those in adults and may considerably affect daily living and social activities. METHOD: This prospective observational cohort study analysed principal disorders that caused vertigo or dizziness in 519 children/adolescents for their demographics, clinical presentation, and diagnostic findings. The main characteristics of distinct disorders were analysed by machine learning techniques to develop a practical diagnostic algorithm. RESULTS: Vestibular migraine was the most frequent diagnosis (41%), followed by functional dizziness (18%), recurrent vertigo of childhood (10%), orthostatic dizziness (6%), and episodic ataxia (3%). Furthermore, 23% of children/adolescents had a rare disorder, for example brain tumours, genetic/congenital disorders, or infections. Children younger than 11 years more commonly had recurrent vertigo of childhood and adolescents from vestibular migraine of childhood. Functional dizziness showed distinct characteristics and a high impact on daily living that differed from those in adults. INTERPRETATION: The diagnostic spectrum of vertigo and dizziness in childhood and adolescence is broad and must be clearly differentiated from known clinical presentation and causes in adults. Especially in young children, clinical presentation may be similar in different vestibular syndromes, but distinct clinical and neuro-ophthalmological findings can lead to the correct diagnosis and avoid broad and unnecessary diagnostic procedures (e.g. magnetic resonance imaging).