Vertigo is an illusion of motion an illusion is a misperception of a real stimulus and represents a disorder of the vestibular proprioceptive system. Benign paroxysmal positional vertigo, acute vestibular neuronitis, and menieres disease cause most cases of vertigo. This post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. The differential diagnosis of dizziness can be narrowed with easytoperform. In this article a differential diagnosis of vertigo is presented. Patients complaining of symptoms of acute vertigo present a diagnostic challenge for the clinician. Migrainous vertigo, or vestibular migraine, is another underlying cause of vertigo that affects about 3 percent of the general population and about 10 percent of per sons with migraine. Pdf differential diagnosis of vertigo zlatko trkanjec. Vertigo is a frequent symptom that results from a variety of etiologies, some benign and others serious. Mar 27, 2015 the table below outlines the differential diagnosis of cervical vertigo know known as cervicogenic dizziness, vertigo, unsteadiness and oscillopsia. Differential diagnosis of vertigo in the emergency department. Dizziness, a common chief complaint, has an extensive differential diagnosis that includes both benign and serious conditions.
Benign paroxysmal positional vertigo is the most common cause of vertigo. This series of movements, done in your doctors office, helps return the. With spontaneous episodic symptoms no trigger, patients have episodes of dizziness lasting seconds to days. Jul 23, 2018 the differential diagnosis of benign paroxysmal positional vertigo can be divided into 3 main areas of pathologylabyrinthine, vestibular nerve, and central. Establishing a diagnosis of benign paroxysmal positional vertigo through the dixhallpike and sidelying maneuvers. The duration of vertigo episodes and associated auditory symptoms will help to narrow the differential diagnosis 5. With regards to peripheral vertigo, benign paroxysmal positional vertigo bppv is the most common cause, accounting for over onehalf of all cases. The main causes of vertigo are benign paroxysmal positional vertigo, meniere disease, vestibular neuritis, and labyrinthitis.
These two common symptoms are common reasons for presentation to physicians offices, absence from work, and disability, and are responsible of % of presentations to the emergency department ed. Because these episodes have no trigger, the patients history establishes the diagnosis. Feb 01, 2017 episodic triggered symptoms are consistent with a diagnosis of benign paroxysmal positional vertigo bppv. Vertigo is among the most common symptoms causing patients to visit a physician, and. Tinnitus and hearing loss precede and worsen with the onset of vertigo. This can result in feelings of vertigo, nausea, and dizziness, and are normally brought on by changes in head or body position. Differential diagnosis differential diagnosis for vertigo. The role of vestibular rehabilitation in the treatment of menieres disease. Differential diagnosis of dizziness yvonne chan introduction dizziness is a nonspeci. Aspects of differential diagnosis article pdf available in neurological sciences 22 suppl 28. Benign paroxysmal positional vertigo bppv statpearls.
Pdf vertigo is the illusion of motion, usually rotational motion. Vertigo that starts without warning, and stops just as. Dizziness, a feeling of motion that persists when the patient and his surroundings are really stationary, can be caused by disorders of the proprioceptive system, the eye, or the ear. Benign positional paroxysmal vertigo bppv is caused by the presence of canaliths in the semicircular canal instead of the utricle. Standing, a fourstep bedside algorithm for differential. Differential diagnoses for benign paroxysmal positional vertigo bppv can be divided into 3 main areas of pathology. It is of great importance to identify bppv versus other causes of vertigo as the differential diagnosis includes a spectrum of diseases processes ranging from benign to lifethreatening. Pdf differential diagnosis of vertigo researchgate. When the ear is involved, the etiology is either central or peripheral. Falling can be a direct consequence of dizziness in this population, and the risk is compounded in elderly persons with other neurologic deficits and chronic medical problems.
Powered by create your own unique website with customizable. A prospective validation study of the standing algorithm. With spontaneous episodic symptoms no trigger, patients have episodes of dizziness. There are some common features of peripheral vertigo that can help your doctor make a diagnosis. Once ves tibular disease is confirmed, emphasis is on differentiat ing peripheral from central causes of vertigo.
This diagnosis should be consid ered after other causes of vertigo have been ruled out. The prevalence of dizziness in the general population ranges from 15% to 30%. Vertigo refers to the subjective feeling of movement of self or the environment in the absence of true movement. Bppv can occur in patients following a head injury, previous. Peripheral differential diagnosis bppv symptoms sudden onset usually with first movement in the morning vertigo of short duration seconds provoked by rolling from supine to position of sagittal plane head movements most describe general imbalance with standing and walking may last for only a day or multiple days or weeksnatural history.
Vertigo is the illusory sense of movement, while unsteadiness is the feeling of being unstable while seated, standing, or walking. Differential diagnosis of dizziness jama jama network. Differential diagnosis of vertigo and dizziness in the emergency department. Dizziness is one of the most common chief complaints, especially in the geriatric agegroup. Flow chart below for differential diagnosis of vertigo and dizziness. Ozono y1, kitahara t, fukushima m, michiba t, imai r, tomiyama y, nishiike s, inohara h, morita h. Once in the canal, movement of the patients head will result movement of these crystals that cause an abnormal movement of endolymph, resulting in vertigo. Vertigo diagnosis and management in primary care british. Differential diagnosis of vertigo and meneiers disease gmch.
Differential diagnosis and treatment of common vestibular. Posterior canal is ruled in if there is upbeating nystagmus, and the direction of torsion demonstrates which side is affected. During the test, the patients eyes will exhibit nystagmus with a torsional component. S847 december 2001 with 842 reads how we measure reads. Bppv results from calcium carbonate debris that becomes dislodged from the otoconial membrane and enters into a semicircular canal kerber, 2009. Because these epi sodes have no trigger, the patients history establishes the diagnosis. Benign positional vertigo in emergency medicine differential. Bppv, the most common cause of peripheral vertigo, can be treated with a 15minute exercise known as the epley maneuver. Clinical diagnosis of benign paroxysmal positional vertigo. Dizziness is a nonspecific term and may be used by patients to indicate true vertigo, lightheadedness, imbalance, or a form of syncope. The incidence of dizziness in the general population is about 20 to 30%. For many doctors, the task of making a satisfactory diagnosis of the cause of vertigo. 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.
Peripheral differential diagnosis bppv benign paroxysmal positional vertigo most common cause of dizziness otoconiabreak free from utricle and fall into the sccs moves the endolymph which deflects the cilia in the cupula etiology adapted from balohet. Differential diagnosis of vertigo and dizziness in the. Pathophysiology, differential diagnosis, and management of. One of the more important differentiating features is determining if the vertigo has a peripheral or central etiology. Benign paroxysmal positional vertigo differential diagnoses. Episodic triggered symptoms are consistent with a diagnosis of benign paroxysmal positional vertigo bppv. Evaluation of dizziness differential diagnosis of symptoms. This is illustrated for various pathologies that cause vertigo, in table 2 this is illustrated for various pathologies that cause vertigo, in table 2. Dix hallpike is used to confirm a diagnosis of bppv in either the anterior or posterior canals. Dizziness is among the most common complaints leading to a visit to a physician for all age groups.
Nov 26, 2018 halker rb, barrs dm, wellik ke, wingerchuk dm, demaerschalk bm. Powered by create your own unique website with customizable templates. Bppv benign paroxysmal positional vertigo, mri magnetic resonance imaging. Mar 21, 2018 benign positional vertigo bpv is the most common cause of vertigo. Jan 02, 2014 however, although the most common causes of dizziness and vertigo are benign, differential diagnosis must include potentially lifethreatening central disease 5.
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