Diagnostic clues

• vertigo can have multiple simultaneous causes (especially in old age)
  • the diagnosis can be vague
• there are features in the history and the examination which help with the diagnosis of vertigo
• clues to diagnosis of causative lesion include (1):
  • duration of vertiginous episodes
  • presence or absence of auditory symptoms
• the physical examination should include (1):
  • measurements of orthostatic vital signs ( blood pressure and pulse)
  • otoscopy
  • neurological examination
    • cranial nerves
    • Dix-Hallpike manoeuvre
      • helps differentiate peripheral from central vertigo
    • Unterberger's stepping test
• laboratory tests (1):
  • usually not indicated
  • if hearing loss is present
    • audiometric tests may be necessary to differentiate vestibular lesions from retro-cochlear lesions (e.g., acoustic neuroma)
  • brain imaging
    • done if a tumour or cerebrovascular accident is suspected

Reference:

1. Swartz R.Treatment of Vertigo.American Family Physician 2005; 71(6)