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
    • Mild
    • Vague
  • Peripheral vertigo
    • Severe
    • Sudden

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
  • Diabetes
  • Recent trauma

Step 4: Do a Neuro Exam

  • Important exam findings for central vertigo
    • Abnormal gait
    • Abnormal finger-to-nose
    • Nystagmus
  • Important exam findings for peripheral vertigo
    • Dix-Hallpike

Step 5: Plan

  • If concerned for CENTAL vertigo
    • MRI head/neck
  • If concerned for PERIPHERAL vertigo
    • Treat with meclizine

Additional Reading

  • Posterior Circulation Strokes and Dizziness (emDOCs)