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
PDF:vertigo
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