Differential diagnosis of vertigo

Abstract

Introduction: Although vertigo is most often of benign etiology and in most cases it is not necessary to have an emergency transport to the health facilities, there is still a huge burden on Emergency Medical Services (EMS). Vertigo can be caused by lesion or dysfunction in vestibular apparatus of the inner ear - peripheral vertigo, while changes in upper parts of the vestibular system define central vertigo. Usually, the description of vertigo complaints is unclear, so recognising central vertigo is a bit difficult, which can have fatal consequences. Distinguishing between the types of vertigo has a significant contribution to the EMS physician's decision-making. Consequently, the management of underlying condition causing central vertigo requires expedited approach by an interprofessional team including the emergency medicine team, the radiologists, the neurologist, and very often the interventional neuroradiologists. Objectives: By presenting the most common differential diagnostic vertiginous entities, the factors will be determined which can help EMS physicians to make the appropriate decision. Methodology: A systematic review of the professional literature was performed in the index databases and leading scientific journals. The findings were systematized based and commented on results and in the discussion. Results: The most common causes of peripheral vertigo are benign paroxysmal positional vertigo, acute vestibular neuronitis/labyrinthitis, Ménière's disease. Cerebrovascular diseases form the largest group of centrally caused vertigo. Using some of the simple diagnostic tests can be helpful in the differential diagnosis of vertigo (Dix-Hallpike maneuver, head-impulse test, ABCD2 score). Conclusion: Detailed anamnesis with data on duration and circumstances under which vertigo occurs, clinical examination and additional diagnostic tests ensure a rapid triage procedure and faster transport times to appropriate specialized institutions (if necessary).

Keywords

• peripheral vertigo
• central vertigo
• emergency medical services
• differential diagnosis
• diagnosis