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- Publisher
- Wiley
- Copyright
- Copyright © 2023 Society for Academic Emergency Medicine
- ISSN
- 1069-6563
- eISSN
- 1553-2712
- DOI
- 10.1111/acem.14561
- Publisher site
- See Article on Publisher Site
Abstract
BACKGROUNDPatients presenting to the emergency department (ED) with symptoms of acute vertigo or dizziness represent a diagnostic challenge for the emergency physician.1 Physicians must distinguish the majority of patients who will have a benign or self‐limiting condition from those who might have a more serious cause for the symptoms. A good history and physical examination are the most important tools clinicians have available to risk stratify and narrow the differential diagnosis.2–7 Focus on the timing and the triggers of the symptoms has been proposed.8,9 The most common causes of vertigo include vestibular neuritis; labyrinthitis; benign paroxysmal positional vertigo (BPPV); acoustic neuroma; vestibular migraine; and less likely posterior circulation (vertebrobasilar) transient ischemic attack, ischemic stroke, or intracerebral hemorrhage.A minority of patients presenting with symptoms of acute vertigo might require neuroimaging. Currently, misdiagnoses are frequent and diagnostic testing costs are high.2,10,11 Unfortunately, clinicians overrely on the utility of noncontrast computed tomography (CT) of the head as well as in CT angiography (CTA) for these patients.12,13 Furthermore, the use of neuroimaging for ED patients with dizziness has not been associated with more stroke diagnoses.14 A study on commercial and Medicare Advantage claims for 800,000 adults with new diagnosis of dizziness found CT
Journal
Academic Emergency Medicine – Wiley
Published: May 1, 2023