Vertigo physical examination: Difference between revisions
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**[[Nystagmus]] in Central Cause: Could be in any direction horizontal, vertical, or torsional, non- adaptive. | **[[Nystagmus]] in Central Cause: Could be in any direction horizontal, vertical, or torsional, non- adaptive. | ||
*Hearing: Weber or Rinne's test is done in the clinic or at the bedside to determine if it is conductive or [[sensorineural hearing loss]]. | *Hearing: Weber or Rinne's test is done in the clinic or at the bedside to determine if it is conductive or [[sensorineural hearing loss]]. | ||
*Otoscopic Exam: Can identify [[cholesteatoma]], [[herpes zoster | *Otoscopic Exam: Can identify [[cholesteatoma]], [[herpes zoster oticus]]([[vesicles]] on [[tympanic membrane]]), [[acute]] [[otitis media]]. | ||
*'''HINTS''': '''H'''ead '''I'''mpulse, '''N'''ystagmus, '''T'''est of '''S'''kew (cover/uncover test) to identify if the cause of [[vestibular neuritis]] is central or peripheral. | *'''HINTS''': '''H'''ead '''I'''mpulse, '''N'''ystagmus, '''T'''est of '''S'''kew (cover/uncover test) to identify if the cause of [[vestibular neuritis]] is central or peripheral. | ||
*[[Dix-Hallpike maneuver]] is used to diagnose [[benign paroxysmal positional vertigo]]. [[Dix-Hallpike maneuver]] can also differentiate between central and peripheral, the intensity of induced symptom decreases with repeated [[maneuvers]] in peripheral but less likely to decrease if the lesion is central in origin. | *[[Dix-Hallpike maneuver]] is used to diagnose [[benign paroxysmal positional vertigo]]. [[Dix-Hallpike maneuver]] can also differentiate between central and peripheral, the intensity of induced symptom decreases with repeated [[maneuvers]] in peripheral but less likely to decrease if the lesion is central in origin. | ||
Revision as of 01:39, 8 January 2021
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Vertigo Microchapters |
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Vertigo physical examination On the Web |
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American Roentgen Ray Society Images of Vertigo physical examination |
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Risk calculators and risk factors for Vertigo physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Physical Examination
| Vertigo features that differentiate peripheral vs central | |||||||||||||||||||||||||||||||||||||||||||||||||
| Peripheral | Central | ||||||||||||||||||||||||||||||||||||||||||||||||
| Intermittent Positional Associated factors (tinnitus, hearing loss, unsteadiness) Nystagmus (delayed, rotatory/horizontal, adaptive) Stops with visual fixation | Non-positional Assosiated factors (other cranial nerves involvement - facial droop/dysarthria) Nystagmus (immediate/delayed, rotatory/horizontal/vertical, not adaptive Does not stop with visual fixation | ||||||||||||||||||||||||||||||||||||||||||||||||
Important signs to assess in a patient with vertigo:
- Nystagmus assessment is an important feature to distinguish peripheral from the central cause of vertigo:
- Hearing: Weber or Rinne's test is done in the clinic or at the bedside to determine if it is conductive or sensorineural hearing loss.
- Otoscopic Exam: Can identify cholesteatoma, herpes zoster oticus(vesicles on tympanic membrane), acute otitis media.
- HINTS: Head Impulse, Nystagmus, Test of Skew (cover/uncover test) to identify if the cause of vestibular neuritis is central or peripheral.
- Dix-Hallpike maneuver is used to diagnose benign paroxysmal positional vertigo. Dix-Hallpike maneuver can also differentiate between central and peripheral, the intensity of induced symptom decreases with repeated maneuvers in peripheral but less likely to decrease if the lesion is central in origin.
- Hennebert’s sign, pushing tragus provokes vertigo or nystagmus on the affected side in patients with perilymphatic fistula.