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Vertigo and dizziness in the emergency room
Andreas Zwergal1,2, Marianne Dieterich1,2,3
1Department of Neurology, University Hospital, Ludwig Maximilians University.
Current Opinion in Neurology
|November 20, 2019
Summary
Swiftly identify dangerous causes of acute vertigo and dizziness using new diagnostic algorithms. These tools combine symptom analysis and specific physical exams to improve accuracy in distinguishing serious conditions.
Area of Science:
- Neurology
- Ophthalmology
- Otorhinolaryngology
Background:
- Acute vertigo and dizziness affect many patients, with a significant percentage (25%) having life-threatening diagnoses, including stroke (4-15%).
- Accurate diagnosis is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To update on diagnostic algorithms for acute vertigo and dizziness.
- To emphasize swift identification of potentially harmful causes.
Main Methods:
- Clinical assessment combining symptom features (triggers, duration, history, accompanying symptoms).
- Comprehensive vestibular, ocular motor, and balance examination (e.g., head impulse, nystagmus tests, Romberg's test).
- Application of standardized diagnostic algorithms (HINTS, TriAGe+) for differentiating central and peripheral causes.
Main Results:
- Diagnostic algorithms combining clinical features and specific exams enhance accuracy in differentiating central and peripheral vestibular disorders.
- Neuroimaging (MRI) requires cautious interpretation due to a high false-negative rate (up to 50%) for small acute strokes.
Conclusions:
- Structured clinical assessment, focusing on symptom characteristics and ocular motor/vestibular findings, is key for diagnosing acute vertigo and dizziness.
- Standardized algorithms improve diagnostic accuracy, but challenges remain with transient or atypical presentations.
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