Abstract

Vertigo can be defined as an illusion or hallucination of movement. Vertigo can be caused by many different pathologies, some of which are potentially life threatening. The differential diagnosis of vertigo includes peripheral vestibular causes (i.e., those originating in the peripheral nervous system), central vestibular causes (i.e., those originating in the central nervous system), and other conditions. Benign paroxysmal positional vertigo, acute vestibular neuritis, and Ménière’s disease cause most cases of vertigo; however, the physicians who see the vertigo patients must consider other various causes including cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms. History is the most important part of the assessment. Key questions should be asked and it is vital to establish if the patient is suffering from vertigo or some other complaint such as anxiety or syncope. History alone reveals the diagnosis in roughly three out of four patients complaining of dizziness, although the proportion in patients specifically complaining of vertigo is unknown. When collecting a patient’s history, the physician first must determine whether the patient truly has vertigo versus another type of dizziness. Once it is determined that a patient has vertigo, the next task is to determine whether the patient has a peripheral or central cause of vertigo. Key information from the history includes the timing and duration of the vertigo, what provokes or aggravates it, and whether any associated symptoms exist, especially neurologic symptoms and hearing loss. Other important clues to the diagnosis of vertigo may come from the patient’s medical history, including medications, trauma, or exposure to toxins. A neurological and otological examination should be performed, appropriate to the history. Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging. Because patients with dizziness often have difficulty describing their symptoms, determining the cause can be challenging. An evidence-based approach using knowledge of key historic, physical examination, and radiologic findings for the causes of vertigo can help physicians establish a diagnosis and consider appropriate treatments in vertigo patients.