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Clinical investigations from the RACP

Evaluation of the patient with acute vertigo

Luke Chen, Andrew Bradshaw, Miriam S Welgampola

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Abstract

Vertigo is a disabling symptom that is unpleasant for the patient and challenging for the assessing physician. A focused history and careful bedside examination while the patient is symptomatic often leads to a diagnosis.

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Key Points

  • Vertigo is a disabling symptom, but most causes of vertigo are treatable and benign.
  • A focused history and careful examination when the patient is symptomatic often leads to a diagnosis.
  • When evaluating the dizzy patient, it is important to know whether the vertigo is spontaneous or positional, its duration and its associated symptoms, especially tinnitus, hearing fluctuations and headaches.
  • Inspection for (peripheral v. central) nystagmus, the head impulse test and the Dix Hallpike test are the three key components of the physical examination.
  • Benign positioning vertigo is the most common and correctable form of vertigo.

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