History
When taking a history from a patient with vertigo, the following areas should be considered:
Current symptoms
Details of current symptoms must be identified:
- Onset
- Duration
- Type (horizontal, vertical, subjective or objective)
- Precipitant of vertigo, and any associated symptoms
Risk factors
Risk factors should be identified:
- Previous episodes of vertigo
- Ear problems
- Head trauma
- Use of ototoxic drugs
In addition, a review of risk factors for the central and peripheral causes should be undertaken.
Identifying potentially life-threatening central causes of vertigo is a crucial aspect of the assessment.
Central Causes
Central causes may be gradual or sudden in onset, but typically present as persistent, worsening vertigo.
Other features such as severe head or neck pain or symptoms of brainstem dysfunction i.e cranial nerve palsies or cerebellar symptoms are usually present.
Central vascular causes are more common in the elderly and those with vascular risk factors.
Peripheral Causes
Peripheral vertigo may be associated with symptoms of cochlear dysfunction such as tinnitus or hearing loss, depending on the cause. However, the absence of hearing disturbance does not exclude a peripheral cause such as vestibular neuritis.
Recurrent, very short attacks of vertigo precipitated by particular head movements, e.g. rolling in bed, are typical of BPPV, and hearing is not usually affected.
| Peripheral vertigo | Central vertigo | |
| Onset | Sudden | Occasionally very sudden but usually gradual |
| Nausea and vomiting | Severe | Variable, usually minimal systemic upset |
| Effect of head position | Worsened by position, often single critical position | Little change, associated with more than one position |
| Associated auditory findings (aural fullness, tinnitus, hearing loss etc.) | May be present | Rare |
| Associated neurological symptoms (dysarthria/ diplopia, hemiparesis etc.) | None | Usually present |
taken from ‘acute vertigo’ session.