Vertigo

Does the patient have CENTRAL vertigo (bad) or PERIPHERAL vertigo?











Step 1: How Does Patient Describe the Vertigo?











* Asking the patient to describe their dizziness has since been disproven… (However, the classic teaching is)* Central vertigo* Mild* Vague* Peripheral vertigo* Severe* Sudden











Step 2: What Are the Associated Symptoms?











* Central vertigo frequently associated with “The Dangerous D’s”* Diplopia (double vision)* Dysphagia (difficulty swallowing)* Dysmetria (uncoordinated movement)* Dysarthria (difficulty speaking)











Step 3: Does this Patient Have Risk Factors for Central Vertigo?











* History of stroke* Atrial fibrillation* Diabetes* Recent trauma











Step 4: Do a Neuro Exam











* Important exam findings for central vertigo* Abnormal gait* Abnormal finger-to-nose* Nystagmus* Important exam findings for peripheral vertigo* Dix-Hallpike











Step 5: Plan











* If concerned for CENTAL vertigo* MRI head/neck* If concerned for PERIPHERAL vertigo* Treat with meclizine











Additional Reading











* Posterior Circulation Strokes and Dizziness (emDOCs)