Vertigo in ED

Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be  is it peripheral or central [badness].

  • Peripheral: sudden, short episodes, no neurology, able to walk
  • Central: insidious, prolonged, neurology, older, difficult to walk

Think about the HINTS exam, its particularly good at identifying posterior strokes (however the patient needs to feel dizzy at reg time of the test


DVLA – sudden onset dizziness


Vertigo – Guide to the big 3

1. Any features that mandate imaging?

  • Neurology deficit
  • Significant headache
  • Neck pain
  • Unable to stand or walk
  • Spontaneous vertical nystagmus (i.e. not while doing dix-hallpike)

2. History

  • Short episodes <2 min brought on by movement, no spontaneous nystagmus (i.e. only on move)
    • BPPV > Dix-Hallpike
  • Dizzy for Hours
    • Vestibular neuritis vs central > HINTSplus exam (you can only use HINTS if patient is dizzy and has nystagmus)

Horizontal canal BPPV sounds similar to posterior canal (D-H+eply) but tends sever when moves head when upright – tests and how to treat different

Vestibular migraine

One to think about if patient presents without nystagmus  – patient should state:

  • Recurrent (at least 5 episodes)
  • Lasts unto 72hrs
  • Has a temporal relationship to migraine symptoms (this may be aura symptoms not headache) at least 50% of the time

Apparently 2.5% population get this, most un/miss-diagnosed, metacloprimide can help

search: dizzy, dizziness,

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