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Dizziness and Vertigo Presentations in the Emergency Department

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Emergency Neurology

Abstract

Dizziness and vertigo are common reasons that patients present to the emergency department. Most patients have benign or self-limited causes, but a small proportion harbor a dangerous disorder such as ischemic stroke. In this chapter, we highlight the critical steps in evaluating and managing patients who present with dizziness symptoms in the emergency setting. We focus on the symptom of vertigo and distinguishing peripheral vestibular from central vestibular disorders.

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References

  1. Eagles D, Stiell IG, Clement CM, et al. International survey of emergency physicians’ priorities for clinical decision rules. Acad Emerg Med. 2008;15:177–82.

    Article  PubMed  Google Scholar 

  2. Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995–2004. Acad Emerg Med. 2008;15:744–50.

    Article  PubMed  Google Scholar 

  3. Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:2067–74.

    Article  PubMed  CAS  Google Scholar 

  4. Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc. 2007;82:1329–40.

    Article  PubMed  Google Scholar 

  5. Newman-Toker DE, Dy FJ, Stanton VA, Zee DS, Calkins H, Robinson KA. How often is dizziness from primary cardiovascular disease true vertigo? A systematic review. J Gen Intern Med. 2008;23:2087–94.

    Article  PubMed  Google Scholar 

  6. American Academy of Neurology, online videos. http://www.neurology.org/cgi/content/full/70/22/2067/DC2.

  7. Han BI, Oh HJ, Kim JS. Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo. Neurology. 2006;66:706–10.

    Article  PubMed  Google Scholar 

  8. Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45:737–9.

    Article  PubMed  CAS  Google Scholar 

  9. Lewis RF, Carey JP. Images in clinical medicine. Abnormal eye movements associated with unilateral loss of vestibular function. N Engl J Med. 2006;355:e26.

    Article  PubMed  Google Scholar 

  10. Baloh RW, Honrubia V. Clinical neurophysiology of the vestibular system. 3rd ed. New York: Oxford University Press; 2001.

    Google Scholar 

  11. Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med. 2003;348:1027–32.

    Article  PubMed  Google Scholar 

  12. Strupp M, Arbusow V, Maag KP, Gall C, Brandt T. Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis. Neurology. 1998;51:838–44.

    PubMed  CAS  Google Scholar 

  13. Strupp M, Zingler VC, Arbusow V, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. 2004;351:354–61.

    Article  PubMed  CAS  Google Scholar 

  14. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37:2484–7.

    Article  PubMed  Google Scholar 

  15. Lee H, Sohn SI, Cho YW, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67:1178–83.

    Article  PubMed  CAS  Google Scholar 

  16. Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology. 2008;70:2378–85.

    Article  PubMed  Google Scholar 

  17. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M. Bedside differentiation of vestibular neuritis from central “vestibular pseudoneuritis”. J Neurol Neurosurg Psychiatry. 2008;79:458–60.

    Article  PubMed  CAS  Google Scholar 

  18. Norrving B, Magnusson M, Holtas S. Isolated acute vertigo in the elderly; vestibular or vascular disease? Acta Neurol Scand. 1995;91:43–8.

    PubMed  CAS  Google Scholar 

  19. Radtke A, von Brevern M, Feldmann M, et al. Screening for Meniere’s disease in the general population—the needle in the haystack. Acta Otolaryngol. 2008;128:272–6.

    Article  PubMed  CAS  Google Scholar 

  20. von Brevern M, Zeise D, Neuhauser H, Clarke AH, Lempert T. Acute migrainous vertigo: clinical and oculographic findings. Brain. 2005;128:365–74.

    Article  Google Scholar 

  21. Neuhauser HK, Lempert T. Diagnostic criteria for migrainous vertigo. Acta Otolaryngol. 2005;125:1247–8.

    Article  PubMed  CAS  Google Scholar 

  22. von Campe G, Regli F, Bogousslavsky J. Heralding manifestations of basilar artery occlusion with lethal or severe stroke. J Neurol Neurosurg Psychiatry. 2003;74:1621–6.

    Article  Google Scholar 

  23. von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–5.

    Google Scholar 

  24. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107:399–404.

    PubMed  CAS  Google Scholar 

  25. Aw ST, Todd MJ, Aw GE, McGarvie LA, Halmagyi GM. Benign positional nystagmus: a study of its three-dimensional spatio-temporal characteristics. Neurology. 2005;64:1897–905.

    Article  PubMed  CAS  Google Scholar 

  26. Johkura K. Central paroxysmal positional vertigo: isolated dizziness caused by small cerebellar hemorrhage. Stroke. 2007;38:e26–e7.

    Article  PubMed  Google Scholar 

  27. Sohn SI, Lee H, Lee SR, Baloh RW. Cerebellar infarction in the territory of the medial branch of the superior cerebellar artery. Neurology. 2006;66:115–7.

    Article  PubMed  Google Scholar 

  28. Neuhauser HK, Radtke A, von Brevern M, et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology. 2006;67:1028–33.

    Article  PubMed  CAS  Google Scholar 

  29. Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14:63–8.

    Article  PubMed  Google Scholar 

  30. Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2004;CD003162.

    Google Scholar 

  31. Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71:149–54.

    Article  PubMed  CAS  Google Scholar 

  32. Whitley RJ. A 70-year-old woman with shingles: review of herpes zoster. JAMA. 2009;302:73–80.

    Article  PubMed  CAS  Google Scholar 

  33. Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. 2008;CD006851.

    Google Scholar 

  34. Uscategui T, Doree C, Chamberlain IJ, Burton MJ. Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. 2008;CD006852.

    Google Scholar 

  35. He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2008;CD005582.

    Google Scholar 

  36. Li Q, Chen N, Yang J, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2009;CD006866.

    Google Scholar 

  37. Wei BP, Mubiru S, O’Leary S. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev. 2006;CD003998.

    Google Scholar 

  38. Rauch SD. Clinical practice. Idiopathic sudden sensorineural hearing loss. N Engl J Med. 2008;359: 833–40.

    Article  PubMed  CAS  Google Scholar 

  39. Plontke SK, Lowenheim H, Mertens J, et al. Randomized, double blind, placebo controlled trial on the safety and efficacy of continuous intratympanic dexamethasone delivered via a round window catheter for severe to profound sudden idiopathic sensorineural hearing loss after failure of systemic therapy. Laryngoscope. 2009;119:359–69.

    Article  PubMed  CAS  Google Scholar 

  40. Ho HG, Lin HC, Shu MT, Yang CC, Tsai HT. Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment. Laryngoscope. 2004;114:1184–9.

    Article  PubMed  CAS  Google Scholar 

  41. Marill KA, Walsh MJ, Nelson BK. Intravenous Lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: a randomized clinical trial. Ann Emerg Med. 2000;36:310–9.

    Article  PubMed  CAS  Google Scholar 

  42. Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–8.

    Article  PubMed  Google Scholar 

  43. Oppenheim C, Stanescu R, Dormont D, et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. Am J Neuroradiol. 2000;21: 1434–40.

    PubMed  CAS  Google Scholar 

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Correspondence to Kevin A. Kerber MD .

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Kerber, K.A., Baloh, R.W. (2012). Dizziness and Vertigo Presentations in the Emergency Department. In: Roos, K. (eds) Emergency Neurology. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-88585-8_3

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  • DOI: https://doi.org/10.1007/978-0-387-88585-8_3

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