Vertigo

Peripheral Benign Paroxysmal Positional Vertigo Acute Labyrinthitis Herpes Zoster Meniere’s Disease Labyrinthine Concussion Perilymphatic Fistula Middle Ear Diseases Impacted Cerumen

Central Stroke (Brainstem or Cerebellar) Vertebral Artery Dissection Brainstem / Cerebellar TIA Multiple Sclerosis Migrainous Vertigo

SUMMARY APPROACH TO PATIENT WITH VERTIGO

 1.  It’s probably BPPV:  Sx only occur with head movement, last <1 min.

• Normal Neuro & ENT exam; no stroke Sx (dysarthria, diplopia, dysphagia)
• Dix-Hallpike diagnostic, but if Neg, still Dx BPPV
• Epley Maneuver for Tx

2.  If vertigo new, occurs without head movement, duration >1 min:

• Dx Acute Labyrinthitis; OR
• Send to ED if suggestion of Stroke
• Dx Zoster if facial palsy / vesicles on or in Ear

3.  Recurrent Vertigo (i.e. Hx past ~ episodes) — see Table re:

• Brainstem / Cerebellar TIAs
• Meniere’s
• Perilymphatic Fistula
• Multiple Sclerosis
• Migrainous Vertigo