Vertigo resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: vertigo, BPPV, stroke, dizziness, Meniere-s syndrome

Overview

Vertigo is a specific type of dizziness, and major symptom of a balance disorder characterized by a sudden spinning sensation that occurs internally or externally, and usually occurs when you move your head quickly. This sensation occurs while the body is actually stationary with respect to the surroundings. The effects of vertigo may be slight; it can cause nausea and vomiting and, in severe cases, it may give rise to difficulties with standing and walking.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis


 
 
 
 
 
 
 
 
Subjective sensation of movement of objects around us or of our own body, usually a spinning sensation.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
'''Vertigo'''
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Symptoms of nausea, vomiting, hearing loss, tinnitus, ear fullness, and otalgia
+
History of upper respiratory infection and/or drug ingestion
 
 
 
 
Symptoms of polyuria, polydipsia, weight gain, and hair loss
+
History of chronic disorders
 
 
 
 
Symptoms of neurologic deficit (slurred speech and diplopia)
+
History of head trauma and/or demyelinating disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral vertigo
 
 
 
 
Systemic vertigo
 
 
 
 
Central vertigo
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Common
BPPV
Vestibular neuronitis
Meniere syndrome
Acute otitis media
Uncommon
Ototoxic drugs
Perilymphatic fistula
Acoustic neuroma
 
 
 
 
Diabetes
Hypothyroidism
 
 
 
 
Common
Cerebellar stroke
Vertebrobasilar insufficiency
Brainstem stroke
Migraine
Uncommon
CNS infection
Multiple sclerosis
 
 
 


Diagnosis of benign paroxysmal positional vertigo (BPPV)
Presence of all the following criteria Continuous periods of vertigo triggered by changes in head position.
Vertigo related with twisting, positive nystagmus is triggered by the Dix-Hallpike maneuver.
Presence of a quiescence period between the execution of the Dix-Hallpike maneuver and the beginning of vertigo and nystagmus.
The triggered vertigo and nystagmus rises and then solves within 60 seconds from the onset.

Adapted from The American Academy of Otolaryngology guidelines for benign paroxysmal positional vertigo (DO NOT EDIT).[1]


Treatment

Treatment of vertigo will vary depending on the underlying cause:

Do's

Don'ts

References

  1. 1.0 1.1 Bhattacharyya, Neil; Gubbels, Samuel P.; Schwartz, Seth R.; Edlow, Jonathan A.; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M.; Mahoney, Kathryn; Hollingsworth, Deena B.; Roberts, Richard; Seidman, Michael D.; Steiner, Robert W. Prasaad; Do, Betty Tsai; Voelker, Courtney C. J.; Waguespack, Richard W.; Corrigan, Maureen D. (2017). "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)". Otolaryngology–Head and Neck Surgery. 156 (3_suppl): S1–S47. doi:10.1177/0194599816689667. ISSN 0194-5998.
  2. Edlow JA, Gurley KL, Newman-Toker DE (April 2018). "A New Diagnostic Approach to the Adult Patient with Acute Dizziness". J Emerg Med. 54 (4): 469–483. doi:10.1016/j.jemermed.2017.12.024. PMC 6049818. PMID 29395695.
  3. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (November 2009). "HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging". Stroke. 40 (11): 3504–10. doi:10.1161/STROKEAHA.109.551234. PMC 4593511. PMID 19762709.
  4. Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA, Boggi JO (December 1992). "Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care". Ann. Intern. Med. 117 (11): 898–904. doi:10.7326/0003-4819-117-11-898. PMID 1443950.
  5. Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA, Boggi JO (December 1992). "Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care". Ann. Intern. Med. 117 (11): 898–904. doi:10.7326/0003-4819-117-11-898. PMID 1443950.
  6. Muncie HL, Sirmans SM, James E (February 2017). "Dizziness: Approach to Evaluation and Management". Am Fam Physician. 95 (3): 154–162. PMID 28145669.
  7. Savitz SI, Caplan LR (June 2005). "Vertebrobasilar disease". N. Engl. J. Med. 352 (25): 2618–26. doi:10.1056/NEJMra041544. PMID 15972868.
  8. Hilton M, Pinder D (2004). "The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo". Cochrane Database Syst Rev (2): CD003162. doi:10.1002/14651858.CD003162.pub2. PMID 15106194.
  9. Edlow JA, Gurley KL, Newman-Toker DE (April 2018). "A New Diagnostic Approach to the Adult Patient with Acute Dizziness". J Emerg Med. 54 (4): 469–483. doi:10.1016/j.jemermed.2017.12.024. PMC 6049818. PMID 29395695.
Vertigo
Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts