Does the patient have CENTRAL vertigo (bad) or PERIPHERAL vertigo?
Step 1: How Does Patient Describe the Vertigo?
- Asking the patient to describe their dizziness has since been disproven… (However, the classic teaching is)
- Central vertigo
- Peripheral vertigo
Step 2: What Are the Associated Symptoms?
- Central vertigo frequently associated with “The Dangerous D’s”
- Diplopia (double vision)
- Dysphagia (difficulty swallowing)
- Dysmetria (uncoordinated movement)
- Dysarthria (difficulty speaking)
Step 3: Does this Patient Have Risk Factors for Central Vertigo?
- History of stroke
- Atrial fibrillation
- Recent trauma
Step 4: Do a Neuro Exam
- Important exam findings for central vertigo
- Abnormal gait
- Abnormal finger-to-nose
- Important exam findings for peripheral vertigo
Step 5: Plan
- If concerned for CENTAL vertigo
- MRI head/neck
- If concerned for PERIPHERAL vertigo
- Treat with meclizine
- Posterior Circulation Strokes and Dizziness (emDOCs)