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:
    • 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:
    • Vertebrobasilar stroke: diplopia, dysphagia, dysarthria, and [[numbness or weakness.
    • Vestibular Migraine|: headache, photophobia, visual aura
    • Ménière disease: hearing loss, tinnitus
    • Acute labyrinthitis or vestibular neuritis: recent viral infection
    • Medication induced: aminoglycosides, anticonvulsants(phenytoin), anti-depressants(tricyclic antidepressants, monoamine oxidase), antihypertensives, diuretics (furosemide), barbiturates, cocaine, nitroglycerin, salicylates
  • Test/Examinations:
    • 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