Neuro-otological emergencies.
OBJECTIVE
Physicians find acute vertigo a diagnostic challenge. This article review recent evidence outlining the clinical presentation of acute central and peripheral dizzy syndromes and suggest when clinicians may consider acute neuro-imaging.


RESULTS
Recent evidence highlights the difficulty that acute vertigo may sometimes pose to the clinician. For example, migrainous vertigo may have oculomotor abnormalities suggestive of either central neurological or peripheral vestibular dysfunction. Furthermore, vertebrobasilar stroke syndromes may mimic peripheral disorders such as vestibular neuritis, or when there is hearing involvement may be misdiagnosed as Meniere's disease. In addition to the need for identifying serious conditions in acute vertigo, recent evidence suggests that early steroid treatment in vestibular neuritis may improve long term outcome. Further trials regarding symptomatic outcome are required, however, before routine use of steroids can be recommended in this condition.


CONCLUSIONS
Recent findings have not made the assessment of acute vertigo any easier for the nonspecialist. Although the commonest vertigo syndromes are benign, serious conditions such as stroke may masquerade as a peripheral labyrinthine disorder and conversely benign conditions such as migrainous vertigo may have clinical characteristics of central disorders. These findings re-emphasize the need for a thorough clinical evaluation of the acutely dizzy patient.
Seemungal
Barry M
BM
Academic Department of Neuro-Otology, Division of Neuroscience and Mental Health, Imperial College London, Charing Cross Hospital, London, UK. b.seemungal@imperial.ac.uk
D000208:Acute Disease; D001921:Brain / Q000503:physiopathology*; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000503:physiopathology; D009460:Neurologic Examination; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology; D014717:Vertigo / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D014724:Vestibular Function Tests; D014722:Vestibule, Labyrinth / Q000503:physiopathology*; D000160:Vestibulocochlear Nerve Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*