Diagnosis and management of vertigo.
Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Meniere's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short.
Halmagyi
G M
GM
Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D010173:Palpation / Q000379:methods; D014057:Tomography, X-Ray Computed; D014717:Vertigo / Q000175:diagnosis* / Q000628:therapy*