Vertigo

Peripheral

Central

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
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