A Clinical Approach to Diagnosis and Management of Vertigo in the Emergency Room Setting

Abstract

Abstract Vertigo is a symptom of the illusory movement of spinning. Vertigo is a challenging diagnostic condition in the emergency room as it is a symptom-complex of a large number of benign to life-threatening conditions. Both peripheral vestibular and central nervous system can cause vertigo and it is often impossible to pinpoint the underlying etiology in the acute settings. Historical features such as recurrent vertigo, triggers, duration of vertigo, accompanying symptoms along with meticulous vestibular, and ocular and balance examination can be valuable in delineating peripheral from central vertigo. Currently, the emergency physicians approach majority of vestibular disorders with a mind-set of preventing any errors of omission, so they rely on unwarranted neuroimaging. In most instances, the timing and triggers of vertigo are ignored and characteristic maneuvers to diagnose benign peripheral vertigo are underused, thereby missing nonlife-threatening diagnosis. An urgent neuroimaging is usually indicated for patients with sustained vertigo and suspected central lesions associated with brainstem dysfunction.