Materiały źródłowe

• #1 Diagnosing Vertigo | NYU Langone Health

  https://nyulangone.org/conditions/vertigo/diagnosis

  NYU Langone doctors diagnose vertigo, which is a feeling of spinning, tilting, or disorientation, even when you are still. […] Vertigo occurs when the bodys perception of its position in space is disrupted. […] Doctors may diagnose vertigo as being peripheral or central. Peripheral vertigo is caused by a problem in the inner ear. Central vertigo is caused by a medical condition affecting the area of the brain that controls balance and spatial awareness. […] While a cause of vertigo can sometimes be identified, doctors cannot always determine exactly why it occurs. […] To diagnose vertigo, your doctor relies on information about your medical history, including details about your symptoms. […] An otolaryngologist performs a physical exam to look for signs and symptoms of the cause of vertigo.

• #1 Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482356/

  The differential diagnosis of vertigo is extensive as it can arise from a central or peripheral lesion in the vestibular system. Therefore, it is important to differentiate vertigo from symptoms of disequilibrium and pre-syncope, such as imbalance and lightheadedness. […] The key to arriving at the diagnosis is to differentiate vertigo from other causes of dizziness or imbalance and distinguish central from peripheral causes of vertigo. An accurate diagnosis is essential in life-threatening causes.

• #1 Initial Evaluation of Vertigo | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html

  Knowing the severity of vertigo over time also is helpful. […] For example, in acute vestibular neuronitis, initial symptoms typically are severe but lessen over the next few days. […] In Mnires disease, attacks of vertigo initially increase in severity, then lessen in severity later on. […] Patients complaining of constant vertigo lasting for weeks may have a psychological cause for their symptoms. […] Provoking factors and circumstances around the onset of vertigo may prove useful in narrowing the differential diagnosis to a peripheral vestibular condition. […] If symptoms occur only with positional changes, such as turning over in bed, bending over at the waist and then straightening up, or hyperextending the neck, BPPV is the most likely cause. […] A recent viral upper respiratory infection may precede acute vestibular neuronitis or acute labyrinthitis.

• #1 Dizziness – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dizziness/diagnosis-treatment/drc-20371792

  Diagnosis involves the steps your healthcare professional takes to find the cause of your dizziness or vertigo. […] You may need imaging tests such as an MRI or a CT scan right away if your healthcare professional thinks you might be having or may have had a stroke. […] You also may need one of these imaging tests if you are older or had a blow to the head. […] Your healthcare professional asks you about your symptoms and the medicines you take. […] Then you’ll likely have a physical exam. […] During this exam, your healthcare professional checks how you walk and maintain your balance. […] The major nerves of your central nervous system also are checked to make sure they’re working. […] You also may need a hearing test and balance tests, including: […] Your healthcare professional may watch the path of your eyes when you track a moving object.

• #1 How to Diagnose Vertigo – National Dizzy & Balance Center

  https://www.nationaldizzyandbalancecenter.com/how-to-diagnose-vertigo/

  Vertigo is the unpleasant sensation of feeling off balance, often described as a dizzy spell. If you suffer from vertigo, you may feel like you are spinning or, conversely, like the world around you is spinning. And while vertigo is often caused by an inner ear problem, there are several factors to take into consideration when it comes to how to diagnose vertigo. […] Before a doctor can properly diagnose vertigo, they must first determine if the vertigo is peripheral or central. […] Peripheral vertigo is the most common type of vertigo, and problems in the inner ear typically cause it. […] Central vertigo, on the other hand, begins outside of the inner ear. […] The first vertigo test doctors typically run is known as the Dix-Hallpike maneuver. […] If the Dix-Hallpike maneuver is inconclusive, doctors often opt for audiometric tests.

• #1 Initial Evaluation of Vertigo | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html

  Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging. […] The differential diagnosis of vertigo includes peripheral vestibular causes (i.e., those originating in the peripheral nervous system), central vestibular causes (i.e., those originating in the central nervous system), and other conditions. […] Ninety-three percent of primary care patients with vertigo have benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, or Mnires disease. […] The Dix-Hallpike maneuver may be the most helpful test to perform on patients with vertigo. […] It has a positive predictive value of 83 percent and a negative predictive value of 52 percent for the diagnosis of BPPV.

• #1 Central Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441861/

  Central vertigo most commonly occurs due to ischemia of the central vestibular structures in the cerebellum, brainstem, or vestibular nuclei, especially in older adults with vascular risk factors. […] The diagnosis is more straightforward when the patient presents with recurrent vertigo associated with typical migraine headaches. […] The HINTS test must be performed on every patient suspected of central vertigo. […] The vestibulo-ocular reflex test or head thrust (also called the head impulse test) forms the basis of a clinical examination to differentiate central vertigo from peripheral vertigo. […] The prognosis of central vertigo depends on the underlying cause. […] Central vertigo presents a significant challenge in healthcare due to its potentially severe consequences if not promptly identified and managed.

• #1 Dizziness: Approach to Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p154.html

  Dizziness is a common yet imprecise symptom. It was traditionally divided into four categories based on the patient’s history: vertigo, presyncope, disequilibrium, and light-headedness. […] Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss suggests Meniere disease. […] The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies. […] TiTrATE is a novel diagnostic approach to determine the probable etiology of dizziness or vertigo. […] The HINTS (head-impulse, nystagmus, test of skew) examination can help differentiate a peripheral cause of vestibular neuritis from a central cause. […] Vertigo is the result of asymmetry within the vestibular system or a disorder of the peripheral labyrinth or its central connections.

• #1 Diagnosing Vertigo | NYU Langone Health

  https://nyulangone.org/conditions/vertigo/diagnosis

  An audiologist conducts a variety of hearing tests, also called audiometric tests, to gather information about the ear. […] Videonystagmography is used to evaluate the function of the inner ear using a series of visual and sensory tests. […] Audiologists use rotational chair testing to obtain more information about whether vertigo is of peripheral or central origin. […] In some people with vertigoin particular those who also have hearing lossdoctors may recommend an MRI scan to obtain a closer look at the inner ear and surrounding structures. […] If hearing or sensory tests indicate vertigo of central origin, doctors may refer you to a specialist for neurological testing and treatment.

• #1 Benign paroxysmal positional vertigo (BPPV) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vertigo/diagnosis-treatment/drc-20370060

  Your doctor may do a series of tests to determine the cause of your dizziness. During a physical exam, your doctor will likely look for: […] If your doctor can’t find the cause of your signs and symptoms, he or she may order additional testing, such as: […] The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air. […] This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

• #1 Vertigo: Causes, Symptoms, and Treatment

  https://www.webmd.com/brain/vertigo-symptoms-causes-treatment

  Vertigo Diagnosis […] A primary care doctor or ear-nose-throat (ENT) specialist can diagnose vertigo. The doctor will ask about your symptoms, examine your inner ear, and check your eye movements. […] You may have one or more of these tests to find the cause of your vertigo: […] Hearing tests. These tests check for a problem with the nerve in your inner ear. […] Caloric testing. An audiologist stimulates your inner ear with cold or warm air to see if it makes you dizzy. This test can detect damage to the acoustic nerve. […] Electronystagmography. This test checks your eye movements to see how well the vestibular nerve and other nerves in your inner ear and brain are working. […] Fukuda-Unterberger test. You march in place for 30 seconds with your eyes closed. If you turn or lean to one side, you could have an inner ear problem.

• #1 Initial Evaluation of Vertigo | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html

  The presence of Tullios phenomenon (i.e., nystagmus and vertigo caused by loud noises or sounds at a particular frequency) suggests a peripheral cause for vertigo. […] Significant psychosocial stress can cause patients to complain of vertigo. […] Hearing loss, pain, nausea, vomiting, or neurologic symptoms can help differentiate the cause of vertigo. […] Most causes of vertigo with hearing loss are peripheral, the main exception being a cerebrovascular event involving the internal auditory artery or anterior inferior cerebellar artery. […] Other important clues to the diagnosis of vertigo may come from the patients medical history, including medications, trauma, or exposure to toxins. […] Laboratory tests such as electrolytes, glucose, blood counts, and thyroid function tests identify the etiology of vertigo in fewer than 1 percent of patients with dizziness.

• #1 Initial Evaluation of Vertigo | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html

  Physicians should consider neuroimaging studies in patients with vertigo who have neurologic signs and symptoms, risk factors for cerebrovascular disease, or progressive unilateral hearing loss. […] In general, magnetic resonance imaging is more appropriate than computed tomography for diagnosing vertigo because of its superiority in visualizing the posterior fossa, where most central nervous system disease that causes vertigo is found. […] Not all patients with vertigo need to be referred to a subspecialist.

• #1 Dizziness – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dizziness/diagnosis-treatment/drc-20371792

  If your vertigo may be caused by benign paroxysmal positional vertigo (BPPV), your healthcare professional may do a simple head movement test. […] It’s called the Dix-Hallpike maneuver, and it can confirm that you have BPPV. […] This test tells your healthcare professional which parts of the balance system you rely on the most and which parts may be giving you problems. […] You also may be given blood tests to check for infection. […] You may need other tests to check your heart and blood vessel health too.

• #1 Benign Paroxysmal Positional Vertigo (BPPV): Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv

  Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder. A person with BPPV experiences a sudden spinning sensation whenever they move their head. BPPV isnt a sign of a serious problem. If it doesnt disappear on its own within six weeks, a simple in-office procedure can help ease your symptoms. […] BPPV usually goes away on its own. However, until its successfully treated, it can come back. In some cases, months or even years go by before another episode occurs. […] Your healthcare provider can diagnose BPPV during an office visit. Theyll perform a physical examination and ask questions about your symptoms and medical history. […] The most effective benign paroxysmal positional vertigo treatments involve physical therapy exercises. The goal of these exercises is to move the calcium carbonate particles out of your semicircular canals and back into your utricle.

• #1 Dizziness: Approach to Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p154.html

  If vertigo is described, physicians should ask about hearing loss, which could suggest Meniere disease. […] The auditory symptoms are initially unilateral. […] BPPV is diagnosed with the Dix-Hallpike maneuver. […] Meniere disease causes vertigo and unilateral hearing loss. […] The underlying pathology is excess endolymphatic fluid pressure leading to inner ear dysfunction; however, the exact cause is unknown. […] First-line treatment of Meniere disease involves lifestyle changes, including limiting dietary salt intake to less than 2,000 mg per day, reducing caffeine intake, and limiting alcohol to one drink per day. […] Vestibular neuritis, the second most common cause of vertigo, is thought to be of viral origin. […] Vestibular neuritis is diagnosed on the basis of the clinical history and physical examination. […] The prognosis is excellent, but development of BPPV after an attack of vestibular neuritis may occur in 15% of patients.

• #1 Dizziness (Vertigo) and Balance Problems: Diagnostic Tests | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/dizziness-vertigo-and-balance-problems-diagnostic-tests

  If you are having vertigo or balance problems, your primary care provider may send you to an ENT to help with a diagnosis. […] A problem that affects balance can also affect hearing. […] This is done to determine whether you have spinning or a false impression of motion. This is a simple test your healthcare provider can do in the office to see if dizziness is caused by vertigo. […] Rotational chair testing provides additional information to audiologists regarding the origin of vertigo whether it is peripheral or central. […] An abnormal ECoG may mean you have Meniere’s disease or other health problems. […] This test may be used if your ENT suspects a rare condition like superior semicircular canal dehiscence. This is a hole in the bone that covers the part of the inner ear where fluid circulates and regulates balance. […] This is done to help determine whether your symptoms are related to a fall in blood pressure or a heart issue. This is a called syncope (fainting) or pre-syncope. It is distinct from vertigo with different causes.

• #1 What is Vertigo? Understanding the Different Types of Vertigo, Diagnosis and Treatment | Hearing Health & Technology Matters

  https://hearinghealthmatters.org/dizziness-depot/2023/vertigo-types-diagnosis-treatment/

  Vestibular neuritis is thought to be the result of a viral inflammation of the vestibular nerve that either temporarily or permanently disrupts nerve transmission between the inner ear and the brain. […] The sensation of vertigo due to a vestibular neuritis will be present even if the affected individual is remaining completely still because it is the reduced vestibular input to the brain causing the sensation. […] An audiologist typically completes the assessment and an Otolaryngologist handles the treatment of Meniere’s disease. […] The diagnosis is typically made based on the patient’s symptoms and a pattern of diagnostic test findings that are not typical of other ear disorders. […] Vestibular migraine is thought to be the most common form of central vestibular dysfunction, as well as the second most common cause of recurrent dizziness symptoms.

• #1 What is Vertigo? Understanding the Different Types of Vertigo, Diagnosis and Treatment | Hearing Health & Technology Matters

  https://hearinghealthmatters.org/dizziness-depot/2023/vertigo-types-diagnosis-treatment/

  The current recommended criteria to reach a diagnosis of vestibular migraine suggests that the individual should have had multiple episodes, with dizziness symptoms that last for minutes to hours in duration, with associated migraine symptoms during at least 50% of the episodes. […] Vertigo is relatively common, and most symptoms of vertigo are related to benign vestibular causes, but the only way to reach a diagnosis is to seek help.

• #1 Acute vertigo: getting the diagnosis right | The BMJ

  https://www.bmj.com/content/378/bmj-2021-069850

  All patients presenting with brief episodic acute vertigo or unsteadiness should undergo a Dix-Hallpike manoeuvre […] Consider stroke in patients with new onset acute unilateral hearing loss and vertigo […] Urgent brain imaging is always indicated when acute vertigo is accompanied by other central neurological signs (such as dysphagia, dysarthria, diplopia) […] Severe acute gait ataxia (patient unable to stand without support) is most common with central causes of vertigo (such as cerebellar lesions) rather than inner ear causes […] Acute vertigo represents up to 5% of all admissions to the emergency department.

• #1 Advances in the diagnosis and management of acute vertigo | The Journal of Laryngology & Otology | Cambridge Core

  https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/advances-in-the-diagnosis-and-management-of-acute-vertigo/ED4065FD0734B9DD071BDE98691E6467

  In light of the development of many bedside examination methods, the diagnosis of acute vertigo has advanced dramatically during the past decade or two. […] The ABCD2 is a stroke risk assessment tool based on five parameters (age, blood pressure, clinical features, duration and presence of diabetes) that was initially developed to stratify patients with anterior cerebral ischaemia. […] Regardless of vascular risk factors, around 3060 per cent of patients with posterior circulation strokes will exhibit at least one deficit on neurological examination. […] The sensitivity of brain CT for posterior circulation acute ischaemic stroke ranges from 7 per cent to 42 per cent, such that CT scans are typically not clinically useful and can be misleadingly reassuring. […] Magnetic resonance imaging, on the other hand, is the gold standard for diagnosing acute ischaemic stroke.

• #1 Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482356/

  When combined with a complete history, a focused physical exam can help further elicit a peripheral from a central cause of vertigo. Assessing for nystagmus is a key portion of the physical exam when a patient presents with vertiginous symptoms. […] The acronym STANDING describes a 4-step algorithm based on nystagmus observation and well-known diagnostic maneuvers. It includes the discrimination between spontaneous and positional nystagmus, evaluation of the nystagmus direction, the head impulse test, and the evaluation of equilibrium. […] Treatment of vertigo depends on the etiology, and treating the underlying etiology often improves the symptoms of vertigo. Medications may be useful to suppress vestibular symptoms in acute episodes that may last a few hours to days. […] Patients with benign paroxysmal positional vertigo benefit from non-pharmacologic agents. The primary treatment for BPPV is focused on head rotation maneuvers that displace calcium deposits back to the vestibule through canalith repositioning or the Epley maneuver.

• #1 Machine Learning Techniques for Differential Diagnosis of Vertigo and Dizziness: A Review

  https://www.mdpi.com/1424-8220/21/22/7565

  Vertigo is a sensation of movement that results from disorders of the inner ear balance organs and their central connections, with aetiologies that are often benign and sometimes serious. An individual who develops vertigo can be effectively treated only after a correct diagnosis of the underlying vestibular disorder is reached. […] Recent advances in artificial intelligence promise novel strategies for the diagnosis and treatment of patients with this common symptom. […] Machine learning techniques can be used to visualize, understand, and classify clinical data to create a computerized, faster, and more accurate evaluation of vertiginous disorders. […] This paper provides a review of the literatures from 1999 to 2021 using various feature extraction and machine learning techniques to diagnose vertigo disorders.

• #1 Machine Learning Techniques for Differential Diagnosis of Vertigo and Dizziness: A Review

  https://www.mdpi.com/1424-8220/21/22/7565

  The Dizziness Handicap Inventory (DHI) is a validated questionnaire of twenty questions for quantitative evaluation of the degrees of handicap in the daily lives of patients with vestibular disorders. […] Once data are collected and pre-processed, a machine learning algorithm is chosen, and a model is trained on the data. […] A model to be used for diagnostic assistance should exhibit high sensitivity and high specificity. […] The studies suggest that there is a need to develop a decision support system (DSS) that can cover a wide range of vertiginous diseases, which should be able to collect the input data into a database that may be later used to retrain models and improve accuracy. […] The AI algorithm of the system maps the input data to the most plausible diagnosis.

• #1 Diagnosis & Treatment – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/

  Many people with dizziness, imbalance, or vertigo have trouble obtaining a diagnosis. […] The signs of vestibular disorders are often hard to recognize. […] Patients have a difficult time describing their symptoms. […] Vestibular disorders may stem from the inner ear or the brain, and can therefore require multiple specialists to evaluate. […] A thorough evaluation of your vestibular function may involve: Medical history, Physical examination, Tests of inner ear function, Hearing tests, Balance tests, Vision tests. […] Getting an accurate diagnosis is often dependent on being prepared for your doctor visit. […] Keeping track of your symptoms, activities, triggers, and medications can help you and your doctor identify the cause of your problem, which may lead to a diagnosis. […] There are more than twenty-five known vestibular disorders.

• #1 Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213196

  Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. […] We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed. […] In the diagnosis section, otolaryngologists preferred significantly fewer head CT scans for the cases of posterior canal BPPV (otolaryngologist (30.0%), non-otolaryngologist (50.6%), p 0.01) and nonspecific vertigo (otolaryngologist (61.2%), non-otolaryngologist (85.6%), p 0.01), and were less likely to perform a HINTS procedure for the case of vestibular neuritis (otolaryngologist (62.5%), non-otolaryngologist (84.3%), p 0.01).

• #1 What doctors wish patients knew about vertigo | American Medical Association

  https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-vertigo

  It is important to go to the emergency department if the vertigo is a sudden onset and is associated with the person literally crawling or cannot walk, Dr. Fattal said. […] For vertigo, there is a generic over-the-counter medicine called meclizine. […] Dehydration can put us at risk of being dizzy. […] In the case of BPPV, the one thing you can do is take a vitamin D supplement if youre vitamin D deficient, Dr. Wycherly said. […] For vertigo, what we usually recommend for patients in terms of lifestyle is to track their sodium intake for a period of time, said Dr. Wycherly. […] Vertigo is not just something you need to live with. […] That is why patients should be pursuing vertigo with an ear, nose and throat specialist or start with their primary care physician, Dr. Wycherly said.

• #1 Vertigo Diagnosis: What to Expect

  https://www.everydayhealth.com/neurology/vertigo-how-will-your-doctor-make-diagnosis/

  Vertigo is not a diagnosis, it is a symptom. […] The goal is to figure out the cause of the vertigo. […] If a physician can’t identify the cause of vertigo, they may refer you to an ENT doctor for further testing, known as a vestibular test battery. […] An ENT may refer you to another specialist for magnetic resonance imaging (MRI) or computed tomography (CT) scans to check the underlying causes of vestibular problems. […] Depending on the cause of the vertigo, they can expect treatment and improvement in symptoms over time. […] Vestibular rehabilitation is a type of physical therapy in which a person can retrain their brain to process signals linked to balance using head and eye movements. […] If symptoms don’t improve, contact a primary care physician.

• #2 Vertigo: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21769-vertigo

  Vertigo causes dizziness and makes you feel like you’re spinning when you’re not. It most commonly occurs when there’s an issue with your inner ear. But you can also develop it if you have a condition affecting your brain, like a tumor or stroke. Treatments vary and can include medication, repositioning maneuvers or surgery. […] Vertigo is a symptom of lots of health conditions rather than a disease itself, but it can occur along with other symptoms. […] Vertigo causes vary from person to person and may include: […] A healthcare provider will perform a physical exam and ask questions about your vertigo symptoms. They may also recommend one or more tests to confirm your diagnosis. […] Healthcare providers may perform some tests to diagnose vertigo. These tests can include: […] Vertigo treatment depends on the underlying cause. Healthcare providers use a variety of treatments, which may include:

• #2 How to Diagnose Vertigo – National Dizzy & Balance Center

  https://www.nationaldizzyandbalancecenter.com/how-to-diagnose-vertigo/

  Vertigo is the unpleasant sensation of feeling off balance, often described as a dizzy spell. If you suffer from vertigo, you may feel like you are spinning or, conversely, like the world around you is spinning. And while vertigo is often caused by an inner ear problem, there are several factors to take into consideration when it comes to how to diagnose vertigo. […] Before a doctor can properly diagnose vertigo, they must first determine if the vertigo is peripheral or central. […] Peripheral vertigo is the most common type of vertigo, and problems in the inner ear typically cause it. […] Central vertigo, on the other hand, begins outside of the inner ear. […] The first vertigo test doctors typically run is known as the Dix-Hallpike maneuver. […] If the Dix-Hallpike maneuver is inconclusive, doctors often opt for audiometric tests.

• #2 Vertigo- Diagnosis and management in primary care | British Journal of Medical Practitioners

  https://www.bjmp.org/content/vertigo-diagnosis-and-management-primary-care

  Vertigo is the hallucination of movement of the environment around the patient, or of the patient with respect to the environment. It is not a fear of heights. […] Vertigo may be classified as: Central – due to a brainstem or cerebellar disorder; Peripheral – due to disorders of the inner ear or the Vestibulocochlear (VIIIth) cranial nerve. […] Most patients who complain about dizziness do not have true vertigo: 5 community based studies into dizziness indicated that around 30% of patients were found to have vertigo, rising to 56.4% in an older population. […] 93% of primary care patients with vertigo have either benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, or Mnires disease. […] It is essential to determine whether the patient has a peripheral or central cause of vertigo.

• #2 Dizziness – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dizziness/diagnosis-treatment/drc-20371792

  Diagnosis involves the steps your healthcare professional takes to find the cause of your dizziness or vertigo. […] You may need imaging tests such as an MRI or a CT scan right away if your healthcare professional thinks you might be having or may have had a stroke. […] You also may need one of these imaging tests if you are older or had a blow to the head. […] Your healthcare professional asks you about your symptoms and the medicines you take. […] Then you’ll likely have a physical exam. […] During this exam, your healthcare professional checks how you walk and maintain your balance. […] The major nerves of your central nervous system also are checked to make sure they’re working. […] You also may need a hearing test and balance tests, including: […] Your healthcare professional may watch the path of your eyes when you track a moving object.

• #2 What doctors wish patients knew about vertigo | American Medical Association

  https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-vertigo

  It is important to note that these different diseases that cause vertigo can sometimes manifest in some patients as just dizziness and without a spinning sensation, she said. […] An example of vertigo that is triggered by position change is BPPV, where the loose crystals move when the person changes position, causing the vertigo, said Dr. Fattal. Such causes are very easy to treat. And very easy to diagnose. […] The key is the historywhen it started, how it is changing over time, how long each episode lasts, what are the triggers, and any associated symptoms, she added. […] If the vertigo is only seconds or minutes, then maybe its related to the peripheral causes, but if its lasting hours or days, then you worry more about a brainstem or a brain issue, he said. […] While history is key to diagnosis, a physical exam can help too.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-vertigo.aspx

  Vertigo is a symptom of an underlying condition. Diagnosis of that condition is based on history and investigations. […] Vertigo alone may be diagnosed by patients accounts of his or her experiences. […] Diagnosis attempts to distinguish between causes in the inner ear or in the brain. […] From history the trigger of the vertigo may be assessed. This helps to determine the cause of the condition. […] Duration of vertigo is also indicative of the underlying cause. […] Clinical examination may reveal nystagmus or uncontrolled movement of the eyes. […] Physicians usually perform a detailed neurological examination to detect the underlying cause. […] The Dix-Hallpike maneuver is commonly performed. It is a test that triggers an episode of vertigo. It is often used to confirm cases of BPPV. […] Laboratory investigations for diagnosis include routine blood tests, audiometry tests, and radiological imaging studies.

• #2 Vertigo: Causes, Symptoms, and Treatment

  https://www.webmd.com/brain/vertigo-symptoms-causes-treatment

  Vertigo Diagnosis […] A primary care doctor or ear-nose-throat (ENT) specialist can diagnose vertigo. The doctor will ask about your symptoms, examine your inner ear, and check your eye movements. […] You may have one or more of these tests to find the cause of your vertigo: […] Hearing tests. These tests check for a problem with the nerve in your inner ear. […] Caloric testing. An audiologist stimulates your inner ear with cold or warm air to see if it makes you dizzy. This test can detect damage to the acoustic nerve. […] Electronystagmography. This test checks your eye movements to see how well the vestibular nerve and other nerves in your inner ear and brain are working. […] Fukuda-Unterberger test. You march in place for 30 seconds with your eyes closed. If you turn or lean to one side, you could have an inner ear problem.

• #2 Dix-Hallpike Test for Vertigo Diagnosis: Procedure & Results

  https://www.webmd.com/brain/dix-hallpike-test-vertigo

  Doctors use the Dix-Hallpike test (sometimes called the Dix-Hallpike maneuver) to check for a common type of vertigo called benign paroxysmal positional vertigo, or BPPV. […] If the Dix-Hallpike test didn’t trigger any symptoms, your doctor may want to do other tests to figure out what’s causing your issues. […] If it did, your doctor may move your head in certain ways to help get the crystals out of your semicircular canals and into a place where they can be reabsorbed.

• #2 What Tests Will My Doctor Use to Diagnose Vertigo?

  https://www.everydayhealth.com/neurology/what-tests-will-my-doctor-use-diagnose-vertigo/

  Several tests are used to determine if you have vertigo and whats causing your symptoms. […] Vertigo is a symptom that can be linked to many different medical conditions. […] Many of these exams require special equipment and a trained professional. […] Your physician can tell you what tests are appropriate for your situation. […] After asking about your symptoms, documenting your health history, and performing a general physical exam, your doctor might suggest one or more of the following tests: […] The Dix-Hallpike maneuver is commonly used if your doctor suspects you have benign paroxysmal positional vertigo (BPPV) the most common cause of vertigo. […] This method can also help your physician figure out if your vertigo is due to an inner ear problem or something in your head.

• #2 Advances in the diagnosis and management of acute vertigo | The Journal of Laryngology & Otology | Cambridge Core

  https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/advances-in-the-diagnosis-and-management-of-acute-vertigo/ED4065FD0734B9DD071BDE98691E6467

  Specific oculomotor examinations have been found to distinguish central and peripheral disorders in the acute vestibular syndrome (acute-onset, prolonged dizziness or vertigo). […] The Head Impulse Test is used to assess the vestibulo-ocular reflex. […] An abnormal vestibulo-ocular reflex is usually a sign of a peripheral vestibular disorder, while a normal vestibulo-ocular reflex with the head impulse is a strong sign of a central problem. […] In 2009, Kattah et al. published their seminal paper on the Head Impulse-Nystagmus-Test of Skew examination. […] Along with the Head Impulse-Nystagmus-Test of Skew examination, the evaluation of auditory function with finger rub was subsequently added in 2013, making up the Head Impulse-Nystagmus-Test of Skew plus hearing (HINTS+) examination.

• #2 What Tests Will My Doctor Use to Diagnose Vertigo?

  https://www.everydayhealth.com/neurology/what-tests-will-my-doctor-use-diagnose-vertigo/

  Posturography analyzes your balance and posture. […] Vestibular Evoked Myogenic Potential (VEMP) evaluates whether your nerves and other parts of your body that are associated with the inner ear or balance are working properly. […] These tests, also known as audiometric tests, measure your hearing function and can detect issues in the inner ear. […] An MRI scan may be used to help your doctor identify possible causes for your vertigo symptoms and rule out others. […] A CT scan is often used to let doctors see abnormalities, such as fractures or thinning bone, around the inner ear. […] Sometimes vision tests are recommended to help doctors find a cause for vertigo symptoms. […] A blood test can reveal problems that could be to blame for your dizziness complaints. […] Sometimes allergies are the culprit for vertigo symptoms.

• #2 Dizziness (Vertigo) and Balance Problems: Diagnostic Tests | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/dizziness-vertigo-and-balance-problems-diagnostic-tests

  If you are having vertigo or balance problems, your primary care provider may send you to an ENT to help with a diagnosis. […] A problem that affects balance can also affect hearing. […] This is done to determine whether you have spinning or a false impression of motion. This is a simple test your healthcare provider can do in the office to see if dizziness is caused by vertigo. […] Rotational chair testing provides additional information to audiologists regarding the origin of vertigo whether it is peripheral or central. […] An abnormal ECoG may mean you have Meniere’s disease or other health problems. […] This test may be used if your ENT suspects a rare condition like superior semicircular canal dehiscence. This is a hole in the bone that covers the part of the inner ear where fluid circulates and regulates balance. […] This is done to help determine whether your symptoms are related to a fall in blood pressure or a heart issue. This is a called syncope (fainting) or pre-syncope. It is distinct from vertigo with different causes.

• #2 Vertigo Diagnosis: What to Expect

  https://www.everydayhealth.com/neurology/vertigo-how-will-your-doctor-make-diagnosis/

  Vertigo is not a diagnosis, it is a symptom. […] The goal is to figure out the cause of the vertigo. […] If a physician can’t identify the cause of vertigo, they may refer you to an ENT doctor for further testing, known as a vestibular test battery. […] An ENT may refer you to another specialist for magnetic resonance imaging (MRI) or computed tomography (CT) scans to check the underlying causes of vestibular problems. […] Depending on the cause of the vertigo, they can expect treatment and improvement in symptoms over time. […] Vestibular rehabilitation is a type of physical therapy in which a person can retrain their brain to process signals linked to balance using head and eye movements. […] If symptoms don’t improve, contact a primary care physician.

• #2 What is Vertigo? Understanding the Different Types of Vertigo, Diagnosis and Treatment | Hearing Health & Technology Matters

  https://hearinghealthmatters.org/dizziness-depot/2023/vertigo-types-diagnosis-treatment/

  It has been shown that up to 90% of patients with a symptom of vertigo potentially have vestibular disorders. […] The most common peripheral vestibular disorder is the condition of Benign Paroxysmal Positional Vertigo (BPPV), accounting for anywhere from 17-42% of all patients seen with symptoms of vertigo. […] BPPV is caused when otoconia (calcium carbonate crystals), that are supposed to be on top of the linear vestibular sensors (otoliths), migrate into one of the semi-circular canals. […] Due to how common BPPV is, a number of healthcare professions assess and treat for it, including but not limited to: physicians, audiologists, physical therapists, and occupational therapists. […] There are effective treatments for this condition called canalith repositioning maneuvers (more commonly known as the Epley or Semont maneuvers) that have been shown to greatly expedite the recovery process.

• #2 Benign paroxysmal positional vertigo – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/73

  Benign paroxysmal positional vertigo (BPPV) is a common, often self-limiting condition, but can be chronic and relapsing. […] Diagnosis is based on a suggestive history and physical examination with a positive Dix-Hallpike manoeuvre or a positive supine lateral head turn. Other tests are not usually required. […] Key diagnostic factors include the presence of risk factors, specific provoking positions, brief duration of vertigo, episodic vertigo, severe episodes of vertigo, sudden onset of vertigo, nausea, imbalance, and lightheadedness, absence of associated neurological or otological symptoms, normal neurological examination, positive Dix-Hallpike manoeuvre or positive supine lateral head turn, and normal otological examination. […] 1st investigations to order include the Dix-Hallpike manoeuvre and supine lateral head turns.

• #2 What is Vertigo? Understanding the Different Types of Vertigo, Diagnosis and Treatment | Hearing Health & Technology Matters

  https://hearinghealthmatters.org/dizziness-depot/2023/vertigo-types-diagnosis-treatment/

  Vestibular neuritis is thought to be the result of a viral inflammation of the vestibular nerve that either temporarily or permanently disrupts nerve transmission between the inner ear and the brain. […] The sensation of vertigo due to a vestibular neuritis will be present even if the affected individual is remaining completely still because it is the reduced vestibular input to the brain causing the sensation. […] An audiologist typically completes the assessment and an Otolaryngologist handles the treatment of Meniere’s disease. […] The diagnosis is typically made based on the patient’s symptoms and a pattern of diagnostic test findings that are not typical of other ear disorders. […] Vestibular migraine is thought to be the most common form of central vestibular dysfunction, as well as the second most common cause of recurrent dizziness symptoms.

• #2 Dizziness Evaluation: Overview, Technique, Pathology and Treatment

  https://emedicine.medscape.com/article/1831429-overview

  Mnire disease (or syndrome) typically manifests as a combination of 4 symptoms, namely, hearing that fluctuates in 1 ear, tinnitus that fluctuates in 1 ear, aural fullness, and episodes of vertigo that last for hours. […] The diagnosis is typically made with a high-resolution computed tomography scan. […] Exclude central causes in patients with vertigo.

• #2 Dizziness, vertigo and balance disorders | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dizziness-and-vertigo

  Vestibular migraine can cause vertigo lasting from minutes to days with or without headache. […] In trying to work out the cause of a persons dizziness, investigations may include: medical history, including careful questioning about the nature of the dizziness. […] Treatment for dizziness and balance disorders varies depending on the diagnosis and severity. […] Vestibular rehabilitation is a physiotherapy program that includes balance activities and eye movement exercises, easily practised at home.

• #2 Advances in the diagnosis and management of acute vertigo | The Journal of Laryngology & Otology | Cambridge Core

  https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/advances-in-the-diagnosis-and-management-of-acute-vertigo/ED4065FD0734B9DD071BDE98691E6467

  In light of the development of many bedside examination methods, the diagnosis of acute vertigo has advanced dramatically during the past decade or two. […] The ABCD2 is a stroke risk assessment tool based on five parameters (age, blood pressure, clinical features, duration and presence of diabetes) that was initially developed to stratify patients with anterior cerebral ischaemia. […] Regardless of vascular risk factors, around 3060 per cent of patients with posterior circulation strokes will exhibit at least one deficit on neurological examination. […] The sensitivity of brain CT for posterior circulation acute ischaemic stroke ranges from 7 per cent to 42 per cent, such that CT scans are typically not clinically useful and can be misleadingly reassuring. […] Magnetic resonance imaging, on the other hand, is the gold standard for diagnosing acute ischaemic stroke.

• #2 Advances in the diagnosis and management of acute vertigo | The Journal of Laryngology & Otology | Cambridge Core

  https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/advances-in-the-diagnosis-and-management-of-acute-vertigo/ED4065FD0734B9DD071BDE98691E6467

  The evidence does not support the use of computed tomography to rule out stroke and even early magnetic resonance imaging has limitations. […] The Head Impulse-Nystagmus-Test of Skew and Head Impulse-Nystagmus-Test of Skew plus hearing examinations have both been well validated when used by specialists. […] There is compelling evidence in favour of specific bedside tests for the diagnosis of acute vertigo in the emergency department.

• #2 Machine Learning Techniques for Differential Diagnosis of Vertigo and Dizziness: A Review

  https://www.mdpi.com/1424-8220/21/22/7565

  This paper aims to provide a better understanding of the work done thus far and to provide future directions for research into the use of machine learning in vertigo diagnosis. […] Vertigo, being a common symptom in the general population, merits an organized approach by healthcare practitioners at the levels of primary care, emergency room, and specialty services, in order to secure an early and accurate diagnosis. […] Misdiagnosis at the level of primary care or ER may result in inappropriate or ineffective therapies or referral to an incorrect specialist, thus prolonging the symptoms and increasing the likelihood of associated morbidities. […] Neuhauser H.K. suggests that BPPV and vestibular migraine (VM) are underdiagnosed, while MD is usually overdiagnosed. […] Recently, Ahmadi S.A. et al. proposed that machine learning methods have the potential to perform better than clinical scores in stroke detection.

• #2 Trouble Getting a Diagnosis? – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/trouble-getting-a-diagnosis/

  Many people who suffer from dizziness, imbalance, or vertigo have trouble finding out why. […] Diagnosing a particular vestibular disorder requires expertise and equipment most general practitioners do not have available. […] Vertigo is the most specific symptom and has a specific definition. […] If you suffer from these problems, you may visit doctor after doctor and undergo test after test without receiving a diagnosis. […] Even if your doctor is able to determine the cause of your dizziness originates from your inner ears balance system, which is called the vestibular system, there are many different possibilities. […] Determining exactly which one or which combination of these disorders is causing your problem can take a great deal of time and can require visits to many different specialists who may order and sometimes repeat many different specialized tests.

• #2 Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213196

  In the treatment section, otolaryngologists were significantly less likely to use the Epley maneuver to treat posterior canal BPPV (otolaryngologist (61.2%), non-otolaryngologist (90.5%), p 0.01) or nonspecific vertigo (otolaryngologist (6.0%), non-otolaryngologist (16.7%), p = 0.04). […] There were significant differences in acute vertigo diagnosis and treatment practices between non-otolaryngologists and otolaryngologists from a vignette-based research. These differences might be caused due to variations in the guideline of each specialty. To improve acute vertigo care in Japan, standardized educational systems for acute vertigo are needed.

• #2 An approach to vertigo in general practice

  https://www.racgp.org.au/afp/2016/april/an-approach-to-vertigo-in-general-practice

  Patients should be referred for specialist review if they have symptoms of continuous vertigo, progressive hearing loss, severe ongoing headache, cerebellar signs or if the diagnosis is not clear. […] Vertigo is a common presentation in general practice. […] A careful history is required to elicit features of central or peripheral causes of vertigo. […] Serious causes including CVAs and MS need to be considered. […] Treatment is specific to the cause of vertigo.

• #2 What Tests Will My Doctor Use to Diagnose Vertigo?

  https://www.everydayhealth.com/neurology/what-tests-will-my-doctor-use-diagnose-vertigo/

  Your primary care physician, neurologist, or an ear, nose, and throat (ENT) specialist can perform some assessments to diagnose your vertigo. […] The testing youll need will depend on what your doctor thinks is causing your vertigo symptoms. […] Its important to tell your physician about all of your signs and symptoms, so you both can come up with a strategy to diagnose and treat the underlying condition thats triggering your vertigo episodes. […] Even after extensive testing, a cause for vertigo isnt always identified.

• #2 Vertigo (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/vertigo

  The most common causes of vertigo symptoms in primary care are benign paroxysmal positional vertigo, Meniere’s disease, and vestibular neuronitis. […] In the elderly, common causes of vertigo may present differently with less rotatory vertigo and more nonspecific dizziness and instability than in younger patients, making diagnosis more difficult. […] The key to making a diagnosis is to find out exactly what the patient means by dizzy and then decide whether or not this represents vertigo. […] Assess whether the person has vertigo rather than presyncope, disequilibrium (imbalance), or light-headedness. Vertigo usually causes rotatory or spinning symptoms. […] Determine whether the vertigo is central or peripheral. […] If peripheral vertigo is suspected, use the history and examination findings to differentiate between conditions.

• #2 An approach to vertigo in general practice

  https://www.racgp.org.au/afp/2016/april/an-approach-to-vertigo-in-general-practice

  More serious central causes, such as cerebrovascular accidents (CVAs), tumours and multiple sclerosis (MS), need to be considered. […] Peripheral pathology is associated with symptoms of nausea, vomiting and hearing loss. […] Vertigo with hearing loss is seen in labyrithitis and Mnires disease, whereas hearing loss is not seen in benign paroxysmal positional vertigo (BPPV) and vestibular neuronitis (VN). […] The most common causes of vertigo seen in primary care are BPPV, VN and Mnires disease. […] BPPV is the most common cause of vertigo in clinical practice. […] Mnires disease is an uncommon cause of vertigo. […] VN is caused by inflammation of the vestibular nerve. […] Treatment is tailored to the specific causes of vertigo. Antiemetic medications such as betahistine are used for symptomatic management of acute vertigo.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-vertigo.aspx

  Vertigo is a symptom of an underlying condition. Diagnosis of that condition is based on history and investigations. […] Vertigo alone may be diagnosed by patients accounts of his or her experiences. […] Diagnosis attempts to distinguish between causes in the inner ear or in the brain. […] From history the trigger of the vertigo may be assessed. This helps to determine the cause of the condition. […] Duration of vertigo is also indicative of the underlying cause. […] Clinical examination may reveal nystagmus or uncontrolled movement of the eyes. […] Physicians usually perform a detailed neurological examination to detect the underlying cause. […] The Dix-Hallpike maneuver is commonly performed. It is a test that triggers an episode of vertigo. It is often used to confirm cases of BPPV. […] Laboratory investigations for diagnosis include routine blood tests, audiometry tests, and radiological imaging studies.

• #3 What doctors wish patients knew about vertigo | American Medical Association

  https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-vertigo

  It is important to note that these different diseases that cause vertigo can sometimes manifest in some patients as just dizziness and without a spinning sensation, she said. […] An example of vertigo that is triggered by position change is BPPV, where the loose crystals move when the person changes position, causing the vertigo, said Dr. Fattal. Such causes are very easy to treat. And very easy to diagnose. […] The key is the historywhen it started, how it is changing over time, how long each episode lasts, what are the triggers, and any associated symptoms, she added. […] If the vertigo is only seconds or minutes, then maybe its related to the peripheral causes, but if its lasting hours or days, then you worry more about a brainstem or a brain issue, he said. […] While history is key to diagnosis, a physical exam can help too.

• #3 Benign paroxysmal positional vertigo: Effective diagnosis and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/11/653

  Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals (rocks) in the semicircular canals of the inner ear, is the most common cause of brief symptoms of vertigo secondary to head and body movements. Diagnosing and treating it are simple to do in the medical office. […] Dizziness or vertigo when lying down or changing positions is a strong predictor of BPPV. The condition is easily diagnosed with the Dix-Hallpike and supine roll maneuvers. […] BPPV is one of the most common vestibular causes of dizziness. Royl et al reported that it was the most frequent diagnosis in patients presenting to the emergency department with dizziness. […] BPPV presents as brief episodes of vertigo, typically lasting seconds to minutes and associated with head movement, neck movement, or overall positional changes.

• #3 Machine Learning Techniques for Differential Diagnosis of Vertigo and Dizziness: A Review

  https://www.mdpi.com/1424-8220/21/22/7565

  Many attempts have been made to apply machine learning techniques for the differential diagnosis of vertigo over the last few decades. […] The machine learning models most commonly used in vertigo diagnosis include decision trees, support vector machines (SVM), k-Nearest neighbors (KNN), and deep learning techniques. […] This paper aims to provide a comprehensive analysis of the application of artificial intelligence in the diagnosis of vertigo. […] The diagnostic process of the non-specific symptom of dizziness involves first eliciting information on the patient’s background medical history and then clarifying presenting symptoms. […] In many instances, an expert clinician will arrive upon a diagnosis with the history and examination, in others, the assistance of audio vestibular tests is sought.

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