Vertigo

Summary: <br> Does the patient have CENTRAL vertigo (bad) or PERIPHERAL vertigo?<br> <br> <br> <br> Step 1: How Does Patient Describe the Vertigo?<br> <br> <br> <br> * Asking the patient to describe their dizziness has since been disproven… (However, the classic teaching is)* Central vertigo* Mild* Vague* Peripheral vertigo* Severe* Sudden<br> <br> <br> <br> Step 2: What Are the Associated Symptoms?<br> <br> <br> <br> * Central vertigo frequently associated with “The Dangerous D’s”* Diplopia (double vision)* Dysphagia (difficulty swallowing)* Dysmetria (uncoordinated movement)* Dysarthria (difficulty speaking)<br> <br> <br> <br> Step 3: Does this Patient Have Risk Factors for Central Vertigo?<br> <br> <br> <br> * History of stroke* Atrial fibrillation* Diabetes* Recent trauma<br> <br> <br> <br> Step 4: Do a Neuro Exam<br> <br> <br> <br> * Important exam findings for central vertigo* Abnormal gait* Abnormal finger-to-nose* Nystagmus* Important exam findings for peripheral vertigo* Dix-Hallpike<br> <br> <br> <br> Step 5: Plan<br> <br> <br> <br> * If concerned for CENTAL vertigo* MRI head/neck* If concerned for PERIPHERAL vertigo* Treat with meclizine<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Posterior Circulation Strokes and Dizziness <a href="http://www.emdocs.net/posterior-circulation-strokes-dizziness-pearls-pitfalls/">(emDOCs)</a><br>