Dizziness…the good and the ugly…

The differential diagnosis of vertigo can be broken into peripheral and central causes. It is imperative the Emergency Physician consider central causes of vertigo.

Signs/ Symptoms Differentiating Peripheral and Central Vertigo

 PeripheralCentral
OnsetSudden or InsidiousSudden
Severity of VertigoIntense SpinningIll-defined, may be severe or less intense
Prodromal DizzinessOccurs in up to 25%, often single episodeOccurs in up to 25%, recurrent episodes suggest TIA’s
Intolerant of head movements/Dix-Hallpike ManeuverYesVaries, but often intolerant
Associated Nausea/DiaphoresisFrequentVariable, but often frequent
Auditory SymptomsPoints to peripheral causesMay be present
Proportionality of SymptomsUsually proportionalOften disproportionate
Headache/Neck PainUnusualMore likely
CNS signs/symptomsAbsentUsually present
Head Impulse TestAbnormalOften normal
NystagmusHorizontalVertical/direction-changing
HINTS TestingNegativeAbnormal in at least 1 out of 3 tests
   

EMKF

Emergency Medicine Kenya Foundation (EMKF) is an NGO supporting emergency healthcare providers across Kenya to save lives by strengthening the emergency healthcare system through capacity building, knowledge development, advocacy and research.