View source for Vertigo

==Background==
*Perception of movement (rotational or otherwise) where no movement exists 
*Pathophysiology 
**Mismatch or asymmetric activity of visual, vestibular, and/or proprioceptive systems
*Must distinguish peripheral from central cause
**Peripheral: 8th CN, vestibular apparatus
**Central: Brainstem, cerebellum

==Clinical Features==
{{Central vs. peripheral causes of vertigo table}}

==Differential Diagnosis==
{{Vertigo DDX}}

==Diagnosis==
{{Vertigo workup}}

===[[EBQ: HINTS Exam|HINTS Exam]]===
Proposed as method of distinguishing peripheral cause from cerebellar/brain stem CVA in the Emergency Department population <ref>http://ec.libsyn.com/p/a/d/d/add761f2a2847ea5/hints-exam.pdf?d13a76d516d9dec20c3d276ce028ed5089ab1ce3dae902ea1d01c0873ed8cc5fe910&c_id=2502227</ref><ref>http://www.ncbi.nlm.nih.gov/pubmed/18541870</ref><ref>http://hwcdn.libsyn.com/p/1/c/d/1cd6b38a89c178a1/diff-of-vertigo.pdf?c_id=2502226&expiration=1380995436&hwt=0a8bc67ea910e018a1543ebea192f668</ref>

{{HINTS Exam Procedure}}

{{HINTS Exam Primary Outcome}}

*''If any of the above 3 tests are consistent w/ CVA obtain full work-up (including MRI)''

==Management==
===Peripheral===

Symptomatic control
#Antihistamines: inhibit vestibular stimulation and vestibular-cerebellar pathways
#*[[Meclizine]] (antivert) 25mg PO QID
#*[[Diphenhydramine]] (Benadryl) 25-50mg IM, IV, or PO q4hr
#Anticholinergics
#*Scopolamine transdermal patch 0.5mg (behind ear) QID
#Antidopaminergics
#*Metoclopramide 10-20 IV or PO TID

Cause Reversal
#Epley maneuver (see [[BPPV]])

===Central===
*R/O [[CVA]]
*MRI
*R/O Vascular insufficiency

==Disposition==
*Most patients with peripheral vertigo can be discharged home
*All patients with central vertigo require urgent imaging and consultation while in the ED

==See Also==
*[[Dizziness]]
*[[EBQ:HINTS_Exam]]
*[[Cerebellar Stroke]]
*[[Stroke syndromes]]

==References==
<references/>
[[Category:Neurology]]
[[Category:Featured]]