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)