Vertigo

• Benign Paroxysmal Positional Vertigo (BPPV): Brief episodes of vertigo triggered by head movement, positive Dix-Hallpike test
• Ménière’s Disease: Recurrent episodes of vertigo lasting minutes to hours, associated with hearing loss, tinnitus, and aural fullness
• Vestibular Neuritis: Acute onset of prolonged vertigo, often following a viral illness, no hearing loss
• Labyrinthitis: Acute onset of vertigo with hearing loss, often following a viral infection
• Acoustic Neuroma: Progressive unilateral hearing loss, tinnitus, unsteady gait, less commonly vertigo

• Cerebrovascular Accident (Stroke): Sudden onset vertigo with other neurological signs (e.g., diplopia, dysarthria, hemiparesis)
• Multiple Sclerosis: Vertigo associated with other signs of demyelination (e.g., optic neuritis, sensory changes)
• Migraine-Associated Vertigo: Episodic vertigo associated with headaches, photophobia, and phonophobia
• Tumors (e.g., cerebellopontine angle tumors): Gradual onset of vertigo with other cranial nerve deficits or ataxia
• Vertebrobasilar Insufficiency: Vertigo with transient ischemic symptoms, often precipitated by head or neck movements

Assess the specific symptoms presented by the patient:

• Onset and Duration: Sudden vs. gradual onset, duration of vertigo episodes
• Triggering Factors: Head movements, changes in position, stress, or visual stimuli
• Associated Symptoms: Hearing loss, tinnitus, aural fullness, nausea, vomiting, or neurological symptoms (e.g., diplopia, dysarthria)
• Impact on Daily Activities: Effect on balance, gait, and ability to perform daily tasks

Gather a detailed background including:

• Past Medical History: History of migraines, previous episodes of vertigo, cerebrovascular disease, or demyelinating disorders
• Drug History: Use of ototoxic medications (e.g., aminoglycosides), recent changes in medication, or use of vestibular suppressants
• Family History: Any family history of Ménière’s disease, migraines, or stroke
• Social History: Alcohol consumption, recent stress or trauma, occupation involving heights or machinery, recent travel

• Head Impulse Test (HIT): To differentiate between peripheral and central causes of vertigo, abnormal in peripheral causes
• Dix-Hallpike Maneuver: To diagnose BPPV, positive if it reproduces vertigo and nystagmus
• HINTS Examination: A bedside test to differentiate between central and peripheral vertigo in acute vestibular syndrome
• Neurological Examination: Assess cranial nerves, cerebellar function, and for signs of stroke or multiple sclerosis

• MRI of the Brain: If central causes of vertigo are suspected, particularly to rule out stroke, MS, or tumors
• Audiometry: To assess hearing function, particularly in suspected Ménière’s disease or acoustic neuroma
• Electronystagmography (ENG) or Videonystagmography (VNG): To assess the vestibular function and differentiate between peripheral and central causes
• Blood Tests: To rule out metabolic causes (e.g., glucose levels for hypoglycemia, thyroid function tests)
• Electrocardiogram (ECG): If cardiovascular causes (e.g., arrhythmias) are suspected, particularly in older patients