Month: January 2017

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Does the patient have CENTRAL vertigo (bad) or PERIPHERAL vertigo?

Step 1: How Does Patient Describe the Vertigo?

• Asking the patient to describe their dizziness has since been disproven… (However, the classic teaching is)
• Central vertigo
  • Mild
  • Vague
• Peripheral vertigo
  • Severe
  • Sudden

Step 2: What Are the Associated Symptoms?

• Central vertigo frequently associated with “The Dangerous D’s”
  • Diplopia (double vision)
  • Dysphagia (difficulty swallowing)
  • Dysmetria (uncoordinated movement)
  • Dysarthria (difficulty speaking)

Step 3: Does this Patient Have Risk Factors for Central Vertigo?

• History of stroke
• Atrial fibrillation
• Diabetes
• Recent trauma

Step 4: Do a Neuro Exam

• Important exam findings for central vertigo
  • Abnormal gait
  • Abnormal finger-to-nose
  • Nystagmus
• Important exam findings for peripheral vertigo
  • Dix-Hallpike

Step 5: Plan

• If concerned for CENTAL vertigo
  • MRI head/neck
• If concerned for PERIPHERAL vertigo
  • Treat with meclizine

Additional Reading

• Posterior Circulation Strokes and Dizziness (emDOCs)