Sudden-onset dizziness and vertigo symptoms: assessment and management of vestibular causes

Helen Turner; Claire Lavender; Peter Rea

doi:10.3399/bjgp20X710369

INTRODUCTION

Approximately 2% of adults seek medical attention annually for symptoms of moderate to severe dizziness, with a third of consultations attributable to a vestibular cause.¹ Aside from the healthcare burden, there are significant socioeconomic implications for patients presenting with these symptoms. The diagnosis can be challenging given the wide range of possible causes — both vestibular and non-vestibular (see this graphically online at www.balancedisorderspectrum.info).²

The four most common vestibular diagnoses causing sudden-onset dizziness will be reviewed in detail. These are vestibular neuritis (or neuronitis) (VN), benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), and Ménière’s disease.

DIFFERENTIAL DIAGNOSIS

Both vestibular and non-vestibular causes of dizziness are listed (Supplementary Table 1) but this is not exhaustive.

CLINICAL ASSESSMENT

A detailed history (Supplementary Table 1) can diagnose the majority of both vestibular and non-vestibular causes.

A detailed neuro-otological examination should be undertaken including otoscopy, cranial nerve examination, HINTS examination (Supplementary Table 2), Romberg’s (test of proprioception and dorsal column function) and Unterberger’s test (as per Romberg’s but with the patient marching on the spot, rotating towards side of vestibular hypofunction), and a lying and standing blood pressure reading. Dix–Hallpike testing can be used to diagnose BPPV. Presence of geotropic (beating towards the ground), torsional nystagmus on Dix–Hallpike testing supports a diagnosis of BPPV and can be followed by a therapeutic Epley manoeuvre.

The main concern here is not missing a cerebellar vascular event involving the anterior or …

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