Author: Peter Bakes, MD

Educational Pearls:

• Important to find out if patients mean dysequilibrium, lightheadedness, or vertigo when patients say they are "dizzy."

• Differentiate central vs. peripheral vertigo

• Central vertigo typically present with bulbar syndromes (difficulty swallowing, facial nerve palsy) and cerebellar symptoms (ataxia).

• Peripheral vertigo typically present with sudden onset vertigo with nausea and vomiting in the absence of bulbar symptoms.

• Episodic? BPPV or Meniere's Disease. BPPV has not auditory symptoms and is associated with head position; Meniere's has hearing loss, tinnitus, and ear fullness.

• Constant? Neuronitis has no auditory symptoms, while labyrinthitis has associated hearing loss/tinnitus and is associated with a recent infection (OM).

References

Baloh RW. Differentiating between peripheral and central causes of vertigo. Otolaryngol Head Neck Surg 1998; 119:55.

Chase M, Goldstein JN, Selim MH, et al. A prospective pilot study of predictors of acute stroke in emergency department patients with dizziness. Mayo Clin Proc 2014; 89:173.

Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37:2484.