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Vertigo

James Jason Arnold, FACOFP, FAAFP, DO Reviewed 06/2022
 


BASICS

DESCRIPTION

  • A symptom, not a disease process. Causes can be peripheral or central, benign, or life-threatening.

  • May be described as a sensation of movement (“room spinning”) when no movement is a...

DIAGNOSIS

HISTORY

  • Do not rely on symptom quality—often unreliable. Focus on timing and triggers  (2).

    • TiTrATE is a clinically useful evaluation tool: Timing, Triggers, And a Targeted Evalua...

TREATMENT

GENERAL MEASURES

Treatments depend on cause. 
  • If medication is likely cause: stop medication and reassess  (2)

  • BPPV: Epley maneuver and modified Epley maneuver (2)[A] (Epley maneuver–YouTube) ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Balance exercises should be adhered to for symptom reduction and return to normal activities of daily living (ADLs). 

Patient Monitoring

After 1 to 2 weeks, assess ...

REFERENCES

1
Newman-Toker  DE, Edlow  JA. TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin.  2015;33(3):577–599. [View Abstr...

SEE ALSO

  • Ménière Disease; Motion Sickness; Vertigo, Benign Paroxysmal Positional (BPPV)

  • Algorithm: Dizziness

CODES

ICD10

  • R42 Dizziness and giddiness

  • H81.10 Benign paroxysmal vertigo, unspecified ear

  • H81.49 Vertigo of central origin, unspecified ear

  • H81.399 Other peripheral vertigo, unspecified ear

  • H81.311 Aural v...

CLINICAL PEARLS

  • TiTrATE your assessment.

  • Acute, spontaneous, continuous vertigo with a normal horizontal head impulse, direction-changing nystagmus, and skew deviation (HINTS positive) is highly sensit...

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