The patient with acute vertigo – the role of clinical examination and imaging

Czech version

Authors: Lukáš Martinkovič
Authors‘ workplace: Neurologická klinika 2. LF UK a FN Motol
Published in: Vnitř Lék 2023; 69(E-5): 20-24
Category:
doi: https://doi.org/10.36290/vnl.2023.067

Overview

Vertigo/dizziness or balance disorders are among the most common patients complaints in emergency clinics. Up to 25% of them are potentially life-threatening, especially cardiovascular or cerebrovascular events. The combination of a careful history taking (triggers, duration of difficulties, associated symptoms) and the performance of a basic vestibular examination (nystagmus, oculomotor, head impulse test, positional maneuvers, standing and walking examination) leads to a reliable differentiation of central and peripheral vestibular etiology. Standardized diagnostic algorithms (HINTS, HINTS+, STANDING) are used to identify high-risk patients requiring urgent care. Imaging methods must be interpreted with caution to their low sensitivity in acute phase (sensitivity of non-contrast brain CT for ischemia in the posterior cranial fossa is only 16%, MRI of the brain is false negative in up to 20% of cases in stroke patients in the first 48 hours).

Keywords:

stroke – Neuroimaging – Vertigo – vestibular system – head impulse test – nystagmus

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Article was published in

Internal Medicine

2023 Issue E-5