Clinical diagnosis of benign paroxysmal positional vertigo and vestibular. Peripheral vertigo is the result of a problem with your inner ear, which controls balance. Demonstrate basic skills in vestibular assessment and treatment. Common causes of vertigo in the elderly include bppv, neurolabyrinthitis, trauma, toxins, migraine, and posterior circulation or labyrinthine ischemia, which is particularly associated with posterior inferior cerebellar artery or anterior inferior cerebellar artery ischemia. If you choose to pause the lecture and return at a later time, a natural break time would be after answering the interactive questions. Estimates indicate that at least 20% of all patients who present to the physician complaining of vertigo have benign paroxysmal positional vertigo. Benign paroxysmal positional vertigo bppv is probably the most common single cause of vertigo in the united states. Peripheral vertigo characteristic peripheral central onset sudden gradual intensity severe mild duration minutes weeks timing intermittent. Central vertigo differential diagnoses medscape reference. Differential diagnosis of vertigo and meneiers disease. Expires december 31, 2014 benign paroxysmal positional vertigo accounts for approximately 42% of cases of vertigo seen in primary care settings and is the single most common cause of vertigo in the united states. We would like to show you a description here but the site wont allow us. Vertigo is the sensation of spinning or having ones surroundings spin about them.
When the physician first sees a vertigo patient, the differential diagnosis may include dozens of potential diseases or conditions, says lee eisenberg, md, an otolaryngologist in private practice in englewood, n. Therefore, an accurate otoneurologic investigation paying attention to differential diagnosis aspects should be. Episodic triggered symptoms are consistent with a diagnosis of benign paroxysmal positional vertigo bppv. The dilated third and lateral ventricles provide gross evidence of obstructive hydrocephalus due to pressure exerted by the tumor on the brainstem. Have a good understanding of the anatomy and physiology of the vestibular system. Neurologic manifestations of benign positional vertigo. Current diagnostic procedures for diagnosing vertigo and dizziness. Crucial elements include a thorough history, supplemented by general medical and neurological examinations, as well as laboratory testing. Pdf differential diagnosis of vertigo zlatko trkanjec. What is the rationale for combining dizziness and imbalance into one. History taking in vertigo patients lalsa shilpa perepa clinical audiologist, hearing first, canada. Dizziness and vertigo posted in neurology, otolaryngology on september 16, 2015 by editor types of dizziness. The results of this study extend our previous study of the differential diagnosis of persistent nonvertiginous dizziness 2,9 and complement the findings of other investigators who have examined similar symptoms in patients with anxiety disorders, 16,17 migraine,18 tbi, 6 and dysautonomia. Flow chart below for differential diagnosis of vertigo and dizziness.
To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. Clinical diagnosis of benign paroxysmal positional vertigo and. Ozono y1, kitahara t, fukushima m, michiba t, imai r, tomiyama y, nishiike s, inohara h, morita h. Differential diagnosis rob landel pt, dpt, ocs, cscs note to participants. Thinking through the differential diagnosis dividing the causes into peripheral and central causes is a good way to organize the differential.
A careful case history obtained is useful in differential diagnosis. It occurs most commonly at the round or oval windows, which are the weakest areas of the bony labyrinth. Pdf standing, a fourstep bedside algorithm for differential. Differential diagnosis of dizziness yvonne chan introduction dizziness is a nonspeci. Bppv can often be diagnosed by combining a clinical history with bedside. In the last years, diagnostics of vertigo have experienced a paradigm.
Decisionmaking involved in vertigo differential diagnosis. Vertigo also comes from disease of the auditory system peripheral and central an excellent way to divide the differential diagnosis of dizziness is. Head turn to the right compresses the patent left vert leading to interruption of perfusion. In particular, the investigators want to analyze the sensitivity and specificity of the test for the diagnosis of vertigo of central origin and the reproducibility of the test. This chapter describes the treatment of vertigo through a discussion of its differential diagnosis, medical management, and surgical treatment. Differential diagnostic overlapping exists with regard to brainstem or. Expanding the differential diagnosis of chronic dizziness. This study evaluate the diagnostic accuracy of a simplified clinical algorithm standing for the differential diagnosis of acute vertigo in the emergency department. See approach to the patient with dizziness and evaluation of the patient with vertigo and causes of vertigo.
Typically, the vertigo presents after direct trauma or barotrauma. Clinical features in the differential diagnosis of acute vertigo. A dynamic uncertain causality graphbased differential diagnosis model for. A peripheral cause of vertigo characterized by the triad of fluctuating hearing loss, tinnitus, and episodic vertigo. Dizziness is among the most common complaints leading to a visit to a physician for all age groups. The differential diagnosis of dizziness can be nar rowed with easytoperform physical examination tests, including evaluation for nystagmus, the dixhallpike maneuver, and ortho. Postwhiplash vertigo can combine several mechanisms. It is possible to group these complaints into four types. The differential diagnosis of headache is challenging.
Standing, a fourstep bedside algorithm for differential diagnosis of acute vertigo in the emergency department. Vertigolike symptoms faintness lightheadedness unsteadiness motion intolerance imbalance floating sensation 37. Clinical characteristics of cervicogenicrelated dizziness and vertigo. Diagnosis of that condition is based on history and investigations. With spontaneous episodic symptoms no trigger, patients have episodes of dizziness lasting seconds to days.
Common and important causes of vertigo for doctors and medical students this page is currently being written and will be available soon. There are interactive popup questions throughout this lecture. Vertigo may precede, follow, or simultaneously differential diagnosis of vertigo. Pdf differential diagnosis of vertigo in the emergency. Cause of vertigo often is revealed by history and physical examination. Determine the differential diagnosis for complaints of dizziness. Current diagnostic procedures for diagnosing vertigo and.
Evaluate the timing, triggers, evolution, and context of the patients vertigo to place them in one of the following groups. Patients with a final diagnosis of central vertigo were older than those without p a clinical approach a mukherjee, sk chatterjee, a chakravarty abstract dizziness is a term which is used to describe a variety of sensations. Pdf vertigo is the illusion of motion, usually rotational motion. In migraineassociated vertigo the patient gives a history of acuteonset vertigo that lasts either minutes to a few hours or many hours to even days. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain types of dizziness distinguishing central vs. Bppv benign paroxysmal positional vertigo, mri magnetic resonance imaging. Powered by create your own unique website with customizable templates. One of the most common complaints encountered in the practice of medicine is dizziness. Differential diagnosis of vertigo and dizziness in the emergency department. Differential diagnostic reasoning method for benign paroxysmal. However, by allowing diagnoses made by clinical pattern matching. This slice reveals a level of the brain higher than the acoustic neuroma. Although accreditation for this cecme activity has expired, and the posttest is no longer available, you can still read the full article.
Differential diagnosis for vertigo oxford medical education. Learn a logical approach to the diagnosis, investigation and treatment of patients with vertigo. Frontiers differential diagnosis of vertigo in the. Distinguishing vertigo from other types of dizziness, determining the cause of vertigo, and the differential diagnosis of vertigo are discussed separately. Perilymph fistula is a violation of the barrier between the middle and the inner ear. A ct slice through the brain of a patient with an acoustic neuroma. The trip database provides clinical publications about evidencebased. The differential diagnosis of vertigo varies by age table 2. Differential diagnosis and treatment lydia eviatar, m. Differential diagnosis of vertigo in the ed neurology. Differential diagnosis of vertigo and dizziness in the. It arises because of asymmetry in the vestibular system due to damage to or dysfunction of the labyrinth, vestibular nerve, or central vestibular structures in the brainstem. Differential diagnosis of vertigo in the emergency department. Pdf objective we investigated the reliability and accuracy of a bedside.
Accuracy of a diagnostic algorithm for the differential. Benign paroxysmal positional vertigo bppv is a major cause of vertigo and accounts for approximately 1742% of the cases. Create a comprehensive treatment plan for older adults with dizziness, vertigo andor dysequilibrium. Central vertigo refers to problems within your brain or brainstem. Peripheral vertigo an overview sciencedirect topics. Combined, however, the set of all 3 diagnoses would. Because these epi sodes have no trigger, the patients history establishes the diagnosis. When the subducgs are merged, solutions are proposed for addressing the. Many people find vertigo very disturbing and often report associated nausea and vomiting. Differential diagnosis of episodic vertigo disease history and examination investigations 1 auto immune inner ear disease aied bl rapidly progressive snhl,monthly intervals, recurrent vertigo, ocular inflammation, depigmentation vkh, urti,lrtiwg, recurrent thrombosis,spontaneous. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Equilibrium disorders caused by involvement of brainstem and cerebellar structures are common in patients with multiple sclerosis ms, but peripheral conditions such as benign paroxysmal positional vertigo bppv can be sometimes confused with those of a central origin. In this article a differential diagnosis of vertigo is presented.
Pdf differential diagnosis of vertigo researchgate. From the department of pediatrics pediatric neurology, the bronx lebanon hospital center, and the department of otolaryngology, albert einstein college of medicine, new york abstract. To establish a system of differential diagnosis for vertigodizziness at the emergency department ed, careful historytaking of complications and examinations of nystagmus should be. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition.