[Vertigo and dizziness in the emergency room]

Area of Science:

• Emergency Medicine
• Neurology
• Otolaryngology

Background:

• Vertigo and dizziness are frequent reasons for emergency department visits.
• Causes are broadly classified into neurootological, medical, and psychiatric origins.

Purpose of the Study:

• To outline a systematic diagnostic approach for vertigo and dizziness in the emergency department.
• To differentiate between peripheral and central causes of acute vestibular syndrome.

Main Methods:

• Systematic analysis of patient history, including symptom details and associated factors.
• Clinical examination focusing on vestibular, ocular motor, and cerebellar systems.
• Basal monitoring including vital signs, ECG, and blood tests.

Main Results:

• The HINTS exam (Head Impulse test, Nystagmus, Test of Skew) and assessment of smooth pursuit/saccades are crucial for differentiating peripheral from central causes.
• Non-selective neuroimaging is generally not indicated due to low diagnostic yield.
• Cranial imaging is reserved for specific clinical scenarios suggesting central pathology.

Conclusions:

• A structured diagnostic strategy is essential for effective management of vertigo and dizziness.
• Timely differentiation of etiologies is critical for appropriate treatment, ranging from specific maneuvers to addressing underlying medical conditions.