Vnitr Lek 2023, 69(5):E20-E24 | DOI: 10.36290/vnl.2023.067

The patient with acute vertigo - the role of clinical examination and imaging

Lukáš Martinkovič

Neurologická klinika 2. LF UK a FN Motol

Vertigo/dizziness or balance disorders are among the most common patients complaints in emergency clinics. Up to 25% of them are potentially life-threatening, especially cardiovascular or cerebrovascular events. The combination of a careful history taking (triggers, duration of difficulties, associated symptoms) and the performance of a basic vestibular examination (nystagmus, oculomotor, head impulse test, positional maneuvers, standing and walking examination) leads to a reliable differentiation of central and peripheral vestibular etiology. Standardized diagnostic algorithms (HINTS, HINTS+, STANDING) are used to identify high-risk patients requiring urgent care. Imaging methods must be interpreted with caution to their low sensitivity in acute phase (sensitivity of non-contrast brain CT for ischemia in the posterior cranial fossa is only 16%, MRI of the brain is false negative in up to 20% of cases in stroke patients in the first 48 hours).

Keywords: vertigo, vestibular system, head impulse test, nystagmus, stroke, neuroimaging.

Accepted: September 4, 2023; Published: September 12, 2023  Show citation