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Vertigo

Jeremy S. Raab, MD and James J. Arnold, DO, FACOFP, FAAFP Reviewed 06/2019
 


BASICS

DESCRIPTION

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

  • May be described as a sensation of movement (“room spin...

DIAGNOSIS

HISTORY

  • Avoid overreliance on patient description of how symptoms feel; focus on triggers and timing (1).

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

TREATMENT

GENERAL MEASURES

Treatments depend on cause. 
  • BPPV: Epley maneuver and modified Epley maneuver (1)[A] (Epley maneuver–YouTube) (5)[B]

  • Vestibular neuritis and labyrinthitis

    • Vestibular-suppressant...

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
Muncie H, Sirmans S, James E. Dizziness: approach to evaluation and management. Am Fam Physician.  2017;95(3):154–162. [View Abstract on OvidMedline]
2
Newman-Toker DE, Edlow JA. TiTrAT...

ADDITIONAL READING

Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommitte...

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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