Vertigo diagnostic pathway

 

Adapted from BMJ: diagnosis  in General Practice - vertigo  26/9/2009

Dizziness

Rotatory
Vertigo ?Clinical_features.html

Red Flag symptoms:

  1. Neurological signs and symptoms

  2. Acute deafness

  3. New type or new onset headache

  4. Vertical nystagmus

  1. Presyncope

  2. Disequilibrium

  3. Lightheadedness

 Do “diagnostic” testsDiagnostic_tests.html

Positional vertigo
Torsional nystagmus

Positive Hallpike manoeuvreDiagnostic_tests.htmlDiagnostic_tests.htmlshapeimage_3_link_0shapeimage_3_link_1

Sustained vertigo
Horizontal nystagmus

Positive Thrust testDiagnostic_tests.htmlshapeimage_4_link_0
 Benign Positional Vertigo

Vertigo_diff._diagnosis.html
 Acute vestibular neuritis

Vertigo_diff._diagnosis.html

Transient unilateral hearing loss or tinnitus and previous episodes of dizziness
 Meniere’s disease

Vertigo_diff._diagnosis.html

Consider vestibular migraine if vertigo plus migraine is recurrent and examination normalVertigo_diff._diagnosis.htmlVertigo_diff._diagnosis.htmlshapeimage_9_link_0shapeimage_9_link_1
Urgent referral to exclude:
 Suppurative ear disease
 Cerebellar or lateral medullary infarction or haemorrhage
 Cerebello-pontine tumour
 Brainstem demyelinationVertigo_diff._diagnosis.html
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