Vertigo history and symptoms

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

History and Symptoms

• Important factors in history:
  • Time course

Time course of symptoms	Disease
Lasting a Day or Longer	Vestibular neuronitis, vertebrobasilar ischemia with labyrinth infarct, Brainstem stroke, Inferior cerebellar infarct/bleed
Lasting Minutes to Hours	Meniere’s disease, vertebrobasilar transient ischemic attack (TIA), Migraine headache, Perilymph fistula.
Lasting Seconds	Benign paroxysmal positional vertigo

• • Associated Signs and symptoms:

Disease	Differentiating Signs and Symptoms
Vertebrobasilar stroke	diplopia, dysphagia, dysarthria, and numbness or weakness.

• Test/Exams:
  • 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.

To determine if the cause is central or peripheral

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