Review article

https://doi.org/10.21860/medflum2023_292446

The Approach to the Patient with Acute Peripheral Vertigo

Katarina Radobuljac orcid.org/0009-0000-8029-7075 ; Klinički bolnički centar Rijeka, Zavod za audiologiju i fonijatriju, Rijeka, Hrvatska
Diana Maržić ; Klinički bolnički centar Rijeka, Zavod za audiologiju i fonijatriju, Rijeka, Hrvatska
Nina Čuš ; Klinički bolnički centar Rijeka, Zavod za audiologiju i fonijatriju, Rijeka, Hrvatska
Tatjana Šepić ; Klinički bolnički centar Rijeka, Zavod za audiologiju i fonijatriju, Rijeka, Hrvatska
Vladimira Vuletić ; Sveučilište u Rijeci, Medicinski fakultet, Katedra za neurologiju, Rijeka, Hrvatska

Abstract

Vertigo and dizziness are among the most common reasons for patients to seek medical help and approximately 3.5 % of all emergency department visits are related to them. The acutely dizzy patient can present a diagnostic and management dilemma for emergency departments and physicians in charge of those patients. Hence, it is of great importance to distinguish the life-threatening conditions, which require acute treatment, from “benign”, self-limiting conditions. While the traditional approach to dizziness relies on “symptom quality” or “type”, the new approach is based on symptom timing, triggers, duration, associated symptoms and patient history. Based on timing and triggers, this new approach divides patients into three key categories: acute vestibular syndrome, spontaneous episodic vestibular syndrome and triggered episodic vestibular syndrome. The acute vestibular syndrome (AVS) is defined as the acute onset of persistent dizziness associated with nausea or vomiting, gait instability, nystagmus, and head-motion intolerance lasting longer than 24 hours. AVS is provoked by a variety of central and peripheral causes, the most common of which are vestibular neuritis and acute stroke (posterior circulation). The HINTS (Head Impulse, Nystagmus, Test of Skew) plus protocol is a powerful tool for distinguishing a possible posterior stroke from peripheral vestibular dysfunction and it has been highly recommended recently. The most common causes of peripheral vertigo are benign paroxysmal positioning vertigo (BPPV), vestibular neuritis and Ménière’s disease. In this article we bring a review of new approaches to vertigo which contribute to faster and easier differentiation of benign and life-threatening conditions. A review of the most common types of peripheral vertigo is also included.

Keywords

benign paroxysmal positional vertigo; Meniere disease; vertigo; vestibular neuronitis

Hrčak ID:

292446

URI

https://hrcak.srce.hr/292446

Publication date:

1.3.2023.

Article data in other languages: croatian

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