Vertigo: assessment and management

Elucidation of the cause of vertigo must consist of an adequate history to see if a clinical entity such as BPPV or Meniere's Disease can be recognised, and a general physical examination with emphasis on: The ear--discharge, perforation, fistula sign and hearing. Vestibular system--nystagmus and Romberg test with past pointing and positional testing. CNS--cranial nerves, cerebellar signs and gait. CVS--BP and bruits in neck and cardiac irregularities. Audiogram, ENG and CT or MRI. The specific treatment must be supplemented by sympathetic, symptomatic therapy and reassurance that the condition is not a mystery but clearly defined. The probable cause and lines of treatment available can be explained.