Vertigo

Author: Andrew Appelboam / Editor: Michael Stewart / Reviewer: Michael Stewart, Pragya Mallick, William Gibbs / Code: A5, O9 / Published: 08/09/2013 / Reviewed: 26/02/2026

Vertigo is a false perception of movement. This may be the feeling that the external world is moving around the individual (objective vertigo) or the feeling that the individual themselves is moving (subjective vertigo).

This module explores the presentation, diagnosis and management of patients presenting to the Emergency Department (ED) with vertigo.

By the end of this session you will be able to:

  • Identify the most likely diagnoses in patients presenting with vertigo
  • Explain the difference between peripheral and central causes of vertigo
  • Describe the evidence-based diagnostic and therapeutic manoeuvres which can be used in the emergency department management of patients with vertigo
  • Identify appropriate investigations and follow-up options for patients with vertigo

START MODULE

References

  1. Rivlin W, et al. Practical approach to vertigo: a synthesis of the emerging evidence. Intern Med J. 2022 Mar;52(3):356-364.
  2. National Institute for Health and Care Excellence (NICE). Vertigo. Clinical Knowledge Summaries (CKS) NICE, 2022.
  3. Hanley K, ODowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract. 2001 Aug;51(469):666-71.
  4. Murdin L, Schilder AG. Epidemiology of balance symptoms and disorders in the community: a systematic review. Otol Neurotol. 2015 Mar;36(3):387-92.
  5. Searls DE, Pazdera L, et al. Symptoms and signs of posterior circulation ischemia in the new England medical center posterior circulation registry. Arch Neurol. 2012;69:34651.
  6. Akhtar N, Kamran SI, et al.Ischaemic posterior circulation stroke in State of Qatar. Eur J Neurol. 2009;16:10049.
  7. Kattah JC, Talkad AV, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10.
  8. Kerber KA, et al. Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study. Neurology. 2015 Nov 24;85(21):1869-78.
  9. Rau CJ, Terling L, Elkhodair S, Kaski D. Acute vertigo in the emergency department: use of bedside oculomotor examination. Eur J Emerg Med. 2020 Oct;27(5):381-383.
  10. Warner CL, et al. Clinician’s perspectives in using head impulse-nystagmus-test of skew (HINTS) for acute vestibular syndrome: UK experience. Stroke Vasc Neurol. 2022 Apr;7(2):172-175.
  11. MDCalc. HINTS for Stroke in Acute Vestibular Syndrome. Pearls/Pitfalls. MDCalc.
  12. EM Crit HINTS exam for Diagnosing Posterior Stroke. [internet] EM Crit, 2015.
  13. Djelilovic-Vranic J, et al. Betahistine or Cinnarizine for treatment of Meniere’s disease. Med Arch. 2012;66(6):396-8.
  14. Murdin L, Hussain K, Schilder AG. Betahistine for symptoms of vertigo. Cochrane Database Syst Rev. 2016 Jun 21;2016(6):CD010696.
  15. Hunter BR, Wang AZ, et al. Efficacy of Benzodiazepines or Antihistamines for Patients With Acute Vertigo: A Systematic Review and Meta-analysis. JAMA Neurol. 2022 Sep 1;79(9):846-855.
  16. Kameswaran M, et al. Effectiveness and Safety of Prochlorperazine in Indian Patients with Acute Vertigo: Results from a Large, Prospective, Post-marketing Observational Study. Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3152-3160.
  17. Strupp M, Zingler VC, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. 2004 Jul 22;351(4):354-61.

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