Bedside Evaluation of Vertigo Patients

Vertigo is an “illusion of motion” that occurs when there is an imbalance between the inputs to the two vestibular nuclei. Vertigo can be caused by diseases of the vestibular organ in the inner ear or by disruption of vestibular centers or pathways in the central nervous system. These may originate in the inner ear, such as Ménière’s disease, vestibular neuronitis, and benign paroxysmal positional vertigo (BPPV), or in the central nervous system, such as atherosclerosis of the cerebral arteries, head trauma, cerebral hemorrhage or edema, motion sickness, or sudden and large changes in barometric pressure. In patients presenting to the emergency department or outpatient clinic with vertigo, it is important to perform a differential diagnosis, as there may be peripheral or central causes that require urgent evaluation and treatment. Emergency departments and primary care physicians are usually the first to evaluate patients. With the right clinical approach, it is not difficult to differentiate between peripheral and central causes at the time of initial presentation. The tests to be performed are called “bedside patient evaluation” or “office tests” because they do not require expensive equipment. These tests can also distinguish cases that need to be referred to a center for further evaluation.