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Diagnosis and management of vertigo

GM Halmagyi
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DOI: https://doi.org/10.7861/clinmedicine.5-2-159
Clin Med March 2005
GM Halmagyi
Royal Prince Alfred Hospital, Sydney, Australia
Roles: Neurology Department
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Abstract

Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Menière's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short.

Key Words
  • benign paroxysmal positioning vertigo (BPPV)
  • cerebellar infarction
  • labyrinthitis
  • Menière's disease
  • migraine
  • vertigo
  • vestibular BPV
  • vestibular neuritis
  • © 2005 Royal College of Physicians
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Diagnosis and management of vertigo
GM Halmagyi
Clinical Medicine Mar 2005, 5 (2) 159-165; DOI: 10.7861/clinmedicine.5-2-159

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Diagnosis and management of vertigo
GM Halmagyi
Clinical Medicine Mar 2005, 5 (2) 159-165; DOI: 10.7861/clinmedicine.5-2-159
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