title: [Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine].
abstract: Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. Therefore, every patient with acute vestibular syndrome needs to be evaluated by a structured interview and a systematic physical examination for red flag symptoms which indicate vertebrobasilar infarction. Routinely, the physical examination should cover the head impulse (Halmagyi) test, test for nystagmus as well as the test of skew and in cases of benign paroxysmal positional vertigo, by the Dix-Hallpike maneuver. The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.
authors: Notfallzentrum, Städtisches Klinikum München Bogenhausen, Englschalkinger Strasse 77, Munich, Germany. Christoph.Dodt@klinikum-muenchen.de
authors: C
authors: C
authors: Dodt
authors: E
authors: E
authors: Zelihic
mesh_terms: D000465:Algorithms; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy; D002544:Cerebral Infarction / Q000175:diagnosis / Q000628:therapy; D019091:Critical Pathways; D003937:Diagnosis, Differential; D004244:Dizziness / Q000209:etiology* / Q000628:therapy; D004636:Emergency Service, Hospital; D006801:Humans; D008279:Magnetic Resonance Imaging; D008575:Meniere Disease / Q000175:diagnosis / Q000628:therapy; D008881:Migraine Disorders / Q000175:diagnosis / Q000628:therapy; D010343:Patient Admission; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000628:therapy; D014717:Vertigo / Q000209:etiology* / Q000628:therapy; D014724:Vestibular Function Tests
references: Laryngoscope. 2008 Feb;118(2):378-9
references: 18303394
references: Mayo Clin Proc. 2007 Nov;82(11):1319-28
references: 17976351
references: Acad Emerg Med. 2009 Oct;16(10):970-7
references: 19799573
references: Stroke. 2009 Nov;40(11):3504-10
references: 19762709
references: N Engl J Med. 2003 Mar 13;348(11):1027-32
references: 12637613
references: Nat Clin Pract Neurol. 2006 Mar;2(3):167-72; quiz 173
references: 16932543
references: Lancet. 2007 Jan 27;369(9558):293-8
references: 17258669
references: Lancet Neurol. 2008 Oct;7(10):951-64
references: 18848314
references: Stroke. 2006 Oct;37(10):2484-7
references: 16946161
references: Stroke. 2009 Dec;40(12):3745-51
references: 19797177
references: Mayo Clin Proc. 2007 Nov;82(11):1329-40
references: 17976352
references: Neurology. 2005 Sep 27;65(6):898-904
references: 16186531
references: Ann Emerg Med. 2011 Jan;57(1):34-41
references: 20855127
references: Am J Med. 1989 Mar;86(3):262-6
references: 2919607
references: Ann Emerg Med. 2011 Mar;57(3):257-64
references: 20952097
references: CMAJ. 2011 Jun 14;183(9):E571-92
references: 21576300
references: N Engl J Med. 1998 Sep 3;339(10):680-5
references: 9725927
references: Clin Otolaryngol. 2005 Dec;30(6):511-6
references: 16402975
references: J Eval Clin Pract. 2010 Feb;16(1):186-91
references: 20367831
references: Yonsei Med J. 1996 Feb;37(1):47-51
references: 8967109
references: Acad Emerg Med. 2007 Jan;14(1):63-8
references: 17200515
references: Arch Neurol. 1988 Jul;45(7):737-9
references: 3390028
references: Stroke. 1993 Jan;24(1):76-83
references: 8418555
references: Mayo Clin Proc. 2008 Jul;83(7):765-75
references: 18613993