Evaluation of the patient with vertigo
- Joseph M Furman, MD, PhD
Joseph M Furman, MD, PhD
- University of Pittsburgh
- Jason JS Barton, MD, PhD, FRCPC
Jason JS Barton, MD, PhD, FRCPC
- Professor and Canada Research Chair
- Medicine (Neurology), Ophthalmology, and Visual Sciences
- The University of British Columbia
- Section Editors
- Michael J Aminoff, MD, DSc
Michael J Aminoff, MD, DSc
- Editor-in-Chief — Neurology
- Section Editor — Medical Neurology
- Professor of Neurology
- University of California, San Francisco School of Medicine
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
- Daniel G Deschler, MD, FACS
Daniel G Deschler, MD, FACS
- Section Editor — Otorhinolaryngology
- Professor of Otology and Laryngology
- Harvard Medical School
Vertigo is a symptom of illusory movement. Almost everyone has experienced vertigo as the transient spinning dizziness immediately after turning around rapidly several times. Vertigo can also be a sense of swaying or tilting. Some perceive self-motion whereas others perceive motion of the environment.
Vertigo is a symptom, not a diagnosis. 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.
Vertigo is a troubling problem for many clinicians because it is symptomatic of a large range of diagnoses from benign to immediately life threatening (table 1). However, in most cases, the clinical history, especially the tempo of the symptoms (table 2), with examination findings that distinguish between central and peripheral etiologies (table 3) identify those patients that require urgent diagnostic evaluation.
Vertigo is only one type of dizziness. Other disorders that present with dizziness include presyncopal faintness, disequilibrium, and nonspecific or ill-defined light-headedness. The initial approach to the patient who complains of dizziness is to localize the cause of the symptom into one of these broad categories. This is described separately. (See "Approach to the patient with dizziness".)
This topic will discuss the clinical approach to a patient with vertigo. The pathophysiology, etiology, and treatment of vertigo are discussed separately. (See "Pathophysiology, etiology, and differential diagnosis of vertigo" and "Treatment of vertigo".)
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- Nausea and vomiting
- Postural instability
- Time course
- Aggravating and provoking factors
- Associated symptoms
- Prior medical history
- Other symptoms of vestibular dysfunction
- - Tilt illusion
- - Drop attacks
- - Spatial disorientation
- - Oscillopsia
- - Impaired balance without vertigo
- Gait instability
- Other neurologic signs
- Office hearing tests
- Dix-Hallpike maneuver
- Other vestibular signs
- DIAGNOSTIC TESTS
- Magnetic resonance imaging
- Electronystagmography and video nystagmography
- Vestibular evoked myogenic potentials
- Brainstem auditory evoked potentials
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS