Dizziness as emergency
Béla Büki, Alexander Andrea Tarnutzer · Oxford University Press eBooks · 2013
In cases with acute vertigo and dizziness, potentially dangerous conditions must be distinguished from benign, self-limiting causes. Focal neurologic signs are sometimes subtle and, as they point to dangerous causes, must be searched for. The acute vestibular syndrome (AVS) is most frequently caused by vestibular neuritis (VN) or ischaemic stroke in the brainstem or cerebellum. More than half of patients presenting with AVS due to ischaemic stroke lack obvious focal neurological signs, closely mimicking benign peripheral vestibular disorders (‘vestibular pseudoneuritis’). A careful bedside ocular motor examination—HINTS (Head Impulse test, Nystagmus and Test of Skew)—reliably identifies cerebellar stroke. Transient acute vertigo and dizziness are frequently caused by peripheral entities such as benign paroxysmal positional vertigo (BPPV) and Menière’s disease (MD).