Vertigo - Revision history

Danbot: Strip excess bold

2026-03-22T09:27:00Z

Strip excess bold

← Older revision		Revision as of 09:27, 22 March 2026
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	**Central: Brainstem, cerebellum		**Central: Brainstem, cerebellum
	**Many clinicians ask about presence of "room-spinning" sensation to distinguish lightheadedness vs vertigo, but this distinction may be of limited usefulness		**Many clinicians ask about presence of "room-spinning" sensation to distinguish lightheadedness vs vertigo, but this distinction may be of limited usefulness
	*The ~~'''~~ATTEST~~'''~~ mnemonic can be helpful: ~~'''A'''ssociated~~ symptoms, ~~'''T'''iming~~, ~~'''T'''riggers~~, ~~'''E'''xam '''S'''igns~~ and ~~'''T'''esting~~		*The ATTEST mnemonic can be helpful: Associated symptoms, Timing, Triggers, Exam Signs and Testing
	**Vital for triaging benign vs dangerous conditions (see Clinical features)		**Vital for triaging benign vs dangerous conditions (see Clinical features)
	*In any vertigo presentation, consider nonvertiginous causes such as presyncope, which may be medication-induced in a polypharmacy patient population		*In any vertigo presentation, consider nonvertiginous causes such as presyncope, which may be medication-induced in a polypharmacy patient population

Danbot: Add MedicationDose SMW entries for meclizine, diphenhydramine, metoclopramide, diazepam; doses verified against standard EM references

2026-03-20T17:44:09Z

Add MedicationDose SMW entries for meclizine, diphenhydramine, metoclopramide, diazepam; doses verified against standard EM references

← Older revision		Revision as of 17:44, 20 March 2026
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	**A peripheral vestibular lesion generally produces unidirectional postural instability with preserved walking		**A peripheral vestibular lesion generally produces unidirectional postural instability with preserved walking
	**An inferior cerebellar stroke often causes severe postural instability and falling		**An inferior cerebellar stroke often causes severe postural instability and falling


			==Medication Dosing==
			===Symptomatic Control===
			*{{MedicationDose\|drug=Meclizine\|dose=25 mg QID\|route=PO\|context=Antihistamine (vestibular suppressant)\|indication=Vertigo\|population=Adult}}
			*{{MedicationDose\|drug=Diphenhydramine\|dose=25-50 mg q4hr\|route=IV/IM/PO\|context=Antihistamine (vestibular suppressant)\|indication=Vertigo\|population=Adult}}
			*{{MedicationDose\|drug=Metoclopramide\|dose=10-20 mg TID\|route=IV/PO\|context=Antidopaminergic\|indication=Vertigo\|population=Adult}}
			*{{MedicationDose\|drug=Diazepam\|dose=2.5-10 mg q6hr PRN\|route=PO\|context=Benzodiazepine (vestibular suppressant)\|indication=Vertigo\|population=Adult\|notes=Use with caution in elderly}}

	==See Also==		==See Also==

Bsupat: /* Symptomatic control */

2025-11-29T21:52:40Z

Symptomatic control

← Older revision		Revision as of 21:52, 29 November 2025
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	**[[Diphenhydramine]] (Benadryl) 25-50mg IM, IV, or PO q4hr		**[[Diphenhydramine]] (Benadryl) 25-50mg IM, IV, or PO q4hr
	*[[Anticholinergics]]		*[[Anticholinergics]]
	**[[Scopolamine]] transdermal patch ~~0.5mg~~ (behind ear) ~~QID~~		**[[Scopolamine]] transdermal patch 1mg (behind ear) every 3 days
	*Antidopaminergics		*Antidopaminergics
	**[[Metoclopramide]] 10-20 IV or PO TID		**[[Metoclopramide]] 10-20 IV or PO TID
	*Benzodiazepines		*Benzodiazepines
	**[[Diazepam]] 2.5-10 mg q6h PRN		**[[Diazepam]] 2.5-10 mg q6h PRN
	**use with caution in elderly population		**use with caution in elderly population

	====Cause Reversal====		====Cause Reversal====

Rossdonaldson1: /* Video */

2024-04-17T20:12:46Z

Video

← Older revision		Revision as of 20:12, 17 April 2024
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	*[[Cerebellar Stroke]]		*[[Cerebellar Stroke]]
	*[[Stroke syndromes]]		*[[Stroke syndromes]]

	~~==Video==~~
	~~{{#widget:YouTube\|id= ymzYaCmepd0}}~~

	==References==		==References==

Rossdonaldson1: /* Peripheral */

2023-11-08T16:38:50Z

Peripheral

← Older revision		Revision as of 16:38, 8 November 2023
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	====Symptomatic control====		====Symptomatic control====
	#[[Antihistamines]]: inhibit vestibular stimulation and vestibular-cerebellar pathways		*[[Antihistamines]]: inhibit vestibular stimulation and vestibular-cerebellar pathways
	#*[[Meclizine]] (Antivert) 25mg PO QID		**[[Meclizine]] (Antivert) 25mg PO QID
	#*[[Diphenhydramine]] (Benadryl) 25-50mg IM, IV, or PO q4hr		**[[Diphenhydramine]] (Benadryl) 25-50mg IM, IV, or PO q4hr
	#[[Anticholinergics]]		*[[Anticholinergics]]
	#*[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID		**[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID
	#Antidopaminergics		*Antidopaminergics
	#*[[Metoclopramide]] 10-20 IV or PO TID		**[[Metoclopramide]] 10-20 IV or PO TID
	#Benzodiazepines		*Benzodiazepines
	#*[[Diazepam]] 2.5-10 mg q6h PRN		**[[Diazepam]] 2.5-10 mg q6h PRN
	#*use with caution in elderly population		**use with caution in elderly population

	====Cause Reversal====		====Cause Reversal====

Rossdonaldson1: /* Peripheral */

2023-11-08T16:38:07Z

Peripheral

← Older revision		Revision as of 16:38, 8 November 2023
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	#*use with caution in elderly population		#*use with caution in elderly population

	====Cause Reversal=====		====Cause Reversal====
	*Epley maneuver (see [[BPPV]])		*Epley maneuver (see [[BPPV]])

Rossdonaldson1: /* Peripheral */

2023-11-08T16:37:49Z

Peripheral

← Older revision		Revision as of 16:37, 8 November 2023
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	===Peripheral===		===Peripheral===

	Symptomatic control		====Symptomatic control====
	#[[Antihistamines]]: inhibit vestibular stimulation and vestibular-cerebellar pathways		#[[Antihistamines]]: inhibit vestibular stimulation and vestibular-cerebellar pathways
	#*[[Meclizine]] (Antivert) 25mg PO QID		#*[[Meclizine]] (Antivert) 25mg PO QID
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	#*use with caution in elderly population		#*use with caution in elderly population

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

	===Central===		===Central===

Rossdonaldson1: /* Management */

2023-11-08T16:33:31Z

Management

← Older revision		Revision as of 16:33, 8 November 2023
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	#Benzodiazepines		#Benzodiazepines
	#*[[Diazepam]] 2.5-10 mg q6h PRN		#*[[Diazepam]] 2.5-10 mg q6h PRN
	**use with caution in elderly population		#*use with caution in elderly population

	Cause Reversal		Cause Reversal

Patricklin at 03:01, 14 October 2023

2023-10-14T03:01:56Z

← Older revision		Revision as of 03:01, 14 October 2023
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	==Background==		==Background==
	*Perception of movement (rotational or otherwise) where no movement exists		*Perception of movement (rotational or otherwise) where no movement exists
			**Don't assume that persistent vertigo that worsens with movement is benign; central vertigo may also worsen with movement
	*Pathophysiology		*Pathophysiology
	**Mismatch or asymmetric activity of visual, vestibular, and/or proprioceptive systems		**Mismatch or asymmetric activity of visual, vestibular, and/or proprioceptive systems
	*~~Must distinguish~~ peripheral ~~from~~ central ~~cause~~		*Evaluation should focus on determining whether the etiology is peripheral or central, with a secondary focus on diagnosis
	**Peripheral: 8th CN, vestibular apparatus		**Peripheral: 8th CN, vestibular apparatus
	**Central: Brainstem, cerebellum		**Central: Brainstem, cerebellum
			**Many clinicians ask about presence of "room-spinning" sensation to distinguish lightheadedness vs vertigo, but this distinction may be of limited usefulness
	*The '''ATTEST''' mnemonic can be helpful: '''A'''ssociated symptoms, '''T'''iming, '''T'''riggers, '''E'''xam '''S'''igns and '''T'''esting		*The '''ATTEST''' mnemonic can be helpful: '''A'''ssociated symptoms, '''T'''iming, '''T'''riggers, '''E'''xam '''S'''igns and '''T'''esting
			**Vital for triaging benign vs dangerous conditions (see Clinical features)
			*In any vertigo presentation, consider nonvertiginous causes such as presyncope, which may be medication-induced in a polypharmacy patient population
			**Always take a full medication history

	==Clinical Features==		==Clinical Features==
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	*Triggered episodic vestibular syndrome		*Triggered episodic vestibular syndrome
	**Triggered by movement (change in body position, head mvmt, valsalva)		**Triggered by movement (change in body position, head mvmt, valsalva)
	**Lasts sec to hours with asymptomatic periods in between		**Lasts sec to minute/hours with asymptomatic periods in between
	**Benign:[[BPPV]] (Dix Hallpike), orthostatic [[hypotension]] (fluids)		**Benign:[[BPPV]] (Dix Hallpike), orthostatic [[hypotension]] (fluids), medication-induced effects
	**Dangerous: Posterior Fossa [[brain tumor\|Tumor]]		**Dangerous: Posterior Fossa [[brain tumor\|Tumor]]

	*Spontaneous episodic vestibular syndrome		*Spontaneous episodic vestibular syndrome
	**Distinct onset		**Distinct onset, but without a clear position/motion-induced trigger
	**Lasts min to hours		**Lasts min to hours
	**Typically asymptomatic on presentation		**Typically asymptomatic on presentation
	**Benign: [[Anxiety]], vasovagal syncope, [[Meniere%27s_disease\|Meniere's]]		**Benign: [[Anxiety]], vasovagal syncope, [[Meniere%27s_disease\|Meniere's]], vestibular [[Migraine]]
	**Dangerous: [[TIA]], [[arrhythmia]], [[PE]]		**Dangerous: [[TIA]], [[arrhythmia]], [[PE]]

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	**Abrupt and persistent		**Abrupt and persistent
	**Can be exacerbated by movement but not triggered by it (i.e. symptoms persist at rest & exacerbated with movement)		**Can be exacerbated by movement but not triggered by it (i.e. symptoms persist at rest & exacerbated with movement)
	**Benign: [[Vestibular Neuritis]], [[Labyrinthitis]],		**Benign: [[Vestibular Neuritis]], [[Labyrinthitis]]
	**Dangerous: [[Stroke\|Posterior Stroke]]		**Dangerous: [[Stroke\|Posterior Stroke]]
	**Utilize [[EBQ:HINTS_Exam\|HINTS Exam]] to differentiate		**Utilize [[EBQ:HINTS_Exam\|HINTS Exam]] to differentiate

Beren85: /* Disposition */

2022-06-01T15:23:52Z

Disposition

← Older revision		Revision as of 15:23, 1 June 2022
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	*Most patients with peripheral vertigo can be discharged home		*Most patients with peripheral vertigo can be discharged home
	*All patients with central vertigo require urgent imaging and consultation while in the ED		*All patients with central vertigo require urgent imaging and consultation while in the ED
			*Prior to discharge, a trial of ambulation should be attempted:
			**A peripheral vestibular lesion generally produces unidirectional postural instability with preserved walking
			**An inferior cerebellar stroke often causes severe postural instability and falling

	==See Also==		==See Also==