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

The Emergency Medicine Kenya (EMK) Foundation is a not-for-profit organization registered in Kenya in 2015 that aims to ensure timely, accessible and quality lifesaving emergency care in Kenya.