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Evaluation of the patient with vertigo

Joseph M Furman, MD, PhD
Jason JS Barton, MD, PhD, FRCPC
Section Editors
Michael J Aminoff, MD, DSc
Robert S Hockberger, MD, FACEP
Daniel G Deschler, MD, FACS
Deputy Editor
Janet L Wilterdink, MD


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 symptoms that patients may identify as 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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Literature review current through: Nov 2017. | This topic last updated: Jun 10, 2015.
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