Initial evaluation of vertigo

Area of Science:

• Neurology
• Otolaryngology
• Family Medicine

Background:

• Vertigo is a common symptom with diverse etiologies.
• Common causes include benign paroxysmal positional vertigo, acute vestibular neuronitis, and Meniere's disease.
• Less common but critical causes include cerebrovascular disease, migraine, and intracranial neoplasms.

Purpose of the Study:

• To outline diagnostic approaches for vertigo in family medicine.
• To differentiate between peripheral and central vertigo etiologies.
• To highlight key historical and physical examination findings for accurate diagnosis.

Main Methods:

• Review of common and critical causes of vertigo.
• Emphasis on clinical presentation for differential diagnosis.
• Integration of patient history, physical examination (including Dix-Hallpike maneuver), and neurologic assessment.

Main Results:

• Distinguishing peripheral from central vertigo is essential for appropriate management.
• Specific symptoms like persistent nystagmus suggest central causes requiring advanced work-up.
• History and physical exam are primary tools for initial diagnosis.

Conclusions:

• Family physicians play a key role in the initial evaluation of vertigo.
• A systematic approach combining history, physical exam, and targeted tests aids diagnosis.
• Identifying central vertigo early is critical for timely intervention and management.