This document discusses an approach to vertigo. It begins by distinguishing vertigo, dizziness, and presyncope. A thorough history is important, including descriptions of symptoms, triggers, and associated symptoms. The physical exam includes ear, neurological, HINTS, and Dix-Hallpike tests to differentiate peripheral and central causes. Peripheral causes include BPPV, vestibular neuritis, and Meniere's disease. Central causes are multiple sclerosis, vestibular migraine, acoustic neuroma, posterior circulation stroke, and tumors. Red flags help identify more serious conditions. Symptomatic treatments are discussed.

1. Presented By: Dr. Md. Samiul Haque, MBBS
FCPS P-2 Trainee (Medicine)
HMO, Medicine Unit-2, MMCH
Vertigo: A Practical
Approach

2. Is it really vertigo?
Vertigo is a sensation of movement relative to one’s surroundings i.e. the room
is spinning
Dizziness is disorientation in space, lightheadedness or sense of unsteadiness
i.e. there is no spinning sensation
Presyncope is sensation of lightheadedness or fainting due to cerebral
hypoperfusion
Dysequilibrium difficulty maintaining balance

3. History
● Description of symptoms in patient’s own words
● Time course
○ Duration
○ Sudden vs Gradual
○ Episodic vs Continuous
● Triggers
○ Change in position
○ Trauma
○ Coughing, Straining
● Associated symptoms
○ Nausea, vomiting => Vestibular neuritis
○ Hearing loss, tinnitus => Meniere’s disease
○ Headache, Photophobia => Migraine
○ Concurrent or previous neurologic symptoms => MS, Post. circulation stroke
● Drug History
○ Vestibulotoxic drugs e.g. gentamicin, salicylate, quinine, antihypertensives

4. Physical Exam
● Ear exam
● Thorough nervous system exam
● HINTS exam (Head Impulse, Nystagmus, Test of Skew)
● Dix-Hallpike Test

5. HINTS Exam

6. Dix-Hallpike Test

7. Peripheral vs Central Vertigo

8. Etiology
Peripheral
● BPPV (Most common)
● Vestibular Neuritis
● Meniere's Disease
Central
● Multiple Sclerosis
● Vestibular Migraine
● Acoustic Neuroma (Vestibular
Schwannoma)
● Posterior Circulation Stroke
● Tumor

9. Red Flags in Vertigo

11. Symptomatic Treatment of Vertigo

12. Thank You