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  • Clinical Presentation

    • Sensation of the room spinning or moving, or themselves spinning or moving

    • Must distinguish from orthostasis/presyncope via history

  • Causes: most easily differentiated based on chronicity and triggers rather than description of symptoms

    • BPPV - short duration, very positional, classically nystagmus is horizontal and torsional with the posterior canal being most commonly involved

    • Vestibular neuronitis/labyrinthitis – typically follows URI or ear infections; often self-limited, but can be severe/prolonged, in which case it is treated with steroids

    • Menière’s Disease – tinnitus and low range frequency hearing loss, generally progressive and treated with diuretics, meclizine and sometimes surgeries or intratympanic injections

    • Endolymphatic Leak – usually following trauma or concussive blasts, requires ENT eval and management. Classically a loud sound will cause vertigo and nystagmus

    • vertiginous migraine: usual migraine triggers, may have aura. Episodic nature and often positive family hx of migraine or even vertiginous migraine.

    • Stroke – sudden onset, ask about vascular risk factors, rare cause of isolated vertigo


  • Careful exam of vertigo will be more helpful than random scans, but pt has to be symptomatic for exam to mean anything:

    • HINTS Battery – Head Impulse test, Nystagmus pattern, Test of skew

      • Central pattern – no corrective saccade, multidirectional nystagmus, skew present

      • Peripheral pattern – corrective saccade, unidirectional nystagmus, no skew present

    • Dix-Hallpike Test

    • Cerebellar testing: FNF, HKS, mirroring, gait

    • Outpatient Vestibular function testing with ENT

  • Central patterns will need head and vessel imaging (looking for vertebral dissection or basilar clots)

    • Often, central vertigo is due to centrally acting medications
  • Peripheral causes are varied and often require eval by ENT as an outpatient

  • Treatment with anticholinergics like meclizine or scopolamine is often helpful

  • Vestibular therapy with OT is also very beneficial

Last update: 2022-06-23 17:31:59