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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • it is important to differentiate vertigo from non-rotatory dizziness (presyncope, disequilibrium, lightheadedness). Patients should be asked whether “he/she felt light headed or felt as if the world was spinning around as though he/she had just gotten off a playground roundabout” during a dizzy spell (1)
  • the history is all important and may give a quite good indication of the cause of vertigo. Remember that general medical causes such as anaemia, hypotension and hypoglycaemia may present with dizziness.
  • important points in the history:
    • onset - ask about specific events such as flying, trauma
    • duration (common causes):
      • seconds
        • benign positional vertigo
      • hours
        • Menieres disease
      • weeks
        • labyrinthitis
        • post-head trauma
        • vestibular neuronitis
      • years
        • may be psychogenic
    • associated auditory symptoms - rare in primary CNS lesion
    • other associated symptoms
      • nausea and vomiting in a vestibular cause
      • neurologic symptoms such as visual disturbance, dysarthria in a central lesion
  • examination and tests relevant for the investigating vertigo include:
    • examination of ear drums (Otoscopy/ Pneumatic otoscopy) for:
      • vesicles ( herpes zoster oticus [Ramsay Hunt syndrome])
      • cholesteatoma
    • tuning fork tests for hearing loss
    • cranial nerve examination
      • cranial nerves should be examined for signs of :
        • palsies
        • sensorineural hearing loss
        • nystagmus (2)
    • Hennebert's sign (2)
      • vertigo or nystagmus caused by pushing on the tragus and external auditory meatus of the affected side
      • indicates the presence of a perilymphatic fistula.
    • gait tests:
      • Romberg's sign
        • not particularly useful in the diagnosis of vertigo (2)
      • heel to toe walking test
      • Unterberger's stepping test
    • Dix-Hallpike manoeuvre (2)
    • the most helpful test to perform on patients with vertigo (2)
    • head impulse test/head thrust test
      • useful in recognizing acute vestibulopathy (1)
    • caloric tests
    • special auditory tests
      • audiometry helps establish the diagnosis of Ménière's disease (2)


  • The Hallpike maneuver and the head impulse test are used in primary care to help identify vestibular as opposed to brainstem diseases (1)


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