Vertigo physical examination

Vertigo Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Vertigo from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Vertigo physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Vertigo physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Vertigo physical examination
CDC on Vertigo physical examination
Vertigo physical examination in the news
Blogs on Vertigo physical examination
Directions to Hospitals Treating Vertigo
Risk calculators and risk factors for Vertigo physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

Ear

Vestibular Exam

Provocative Maneuvers

Dix-Hallpike (Baranay): Patient Sitting on Exam Table

• Lies down with head extending over table edge, 45° to one side
• Position change can occur slowly; should be held for > 30 sec
• Repeat with head turned 45° to opposite side, then without turning head
• Peripheral lesion

1. 2-20 sec latency before onset of nystagmus
2. Duration of nystagmus < 1 minute
3. Fatigues with repetition of maneuver
4. One type nystagmus (upbeat and torsional)
5. Severe vertigo (spinning toward normal ear)

• Central lesion:no latency before onset of nystagmus

1. Duration of nystagmus > 1 minute
2. No fatiguability
3. Direction may change with head position
4. Less severe, if any, vertigo

Hearing

• Test gross hearing with whisper/finger tap
• If asymmetric hearing loss:
• Rinne test to confirm sensorineural (vs. conductive) loss

1. Air>bone conduction with sensorineural loss

• Tympanum membrani (TM) exam to rule out acute or chronic otitis media as etiology
• Speech discrimination to assess cochlear or retrocochlear

1. Identification of < 20% of 10 2-syllable words whispered into affected ear suggests retrocochlear lesion (acoustic neuroma)
2. Identification of > 70% of words = cochlear disease
3. Identification of 20-70% = indeterminate (audiology)
4. Audiometry referral to confirm hearing loss

Eye

Nystagmus

Peripheral Lesions

• Horizontal +/- torsional component, never vertical
• Fast phase toward the normal ear
• Never reverses direction
• Suppressed by visual fixation
• (Prevent fixation via Frenzel lenses -> increased nystagmus)

Central Lesions

• Can be in any direction
• May reverse direction when patient looks in direction of slow phase
• Not suppressed by visual fixation

Neurologic

• Cranial nerves
• Motor/sensory deficits,
• Deep tendon reflexes (DTRs)
• Cerebellar signs?
• Central lesion

Romberg

• Unilateral peripheral lesion -> patient leans/falls to side of lesion, but able to walk
• Acute cerebellar lesion -> patient unable to walk without falling; variable direction of fall