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Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and managem...

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Autores principales: Koohi, Nehzat, Male, Amanda J., Kaski, Diego
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585259/
https://www.ncbi.nlm.nih.gov/pubmed/37869150
http://dx.doi.org/10.3389/fneur.2023.1266778
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author Koohi, Nehzat
Male, Amanda J.
Kaski, Diego
author_facet Koohi, Nehzat
Male, Amanda J.
Kaski, Diego
author_sort Koohi, Nehzat
collection PubMed
description INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management. OBJECTIVES: To evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo. METHODS: Following routine ED care, patients with a primary complaint of dizziness, vertigo, light-headedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analyzed. RESULTS: Of 71 consented patients (21−91 years; mean 56 years, ±16.7 years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (mean 48.85 years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88 years, mean 66 years, ±12.22, 5 females), and six with central positional nystagmus (age range 23−59 years, mean 41.67 years, ±15.78, 6 females). CONCLUSION: Positional vertigo should be assessed with positional maneuvers such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity.
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spelling pubmed-105852592023-10-20 Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus Koohi, Nehzat Male, Amanda J. Kaski, Diego Front Neurol Neurology INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management. OBJECTIVES: To evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo. METHODS: Following routine ED care, patients with a primary complaint of dizziness, vertigo, light-headedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analyzed. RESULTS: Of 71 consented patients (21−91 years; mean 56 years, ±16.7 years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (mean 48.85 years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88 years, mean 66 years, ±12.22, 5 females), and six with central positional nystagmus (age range 23−59 years, mean 41.67 years, ±15.78, 6 females). CONCLUSION: Positional vertigo should be assessed with positional maneuvers such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity. Frontiers Media S.A. 2023-10-05 /pmc/articles/PMC10585259/ /pubmed/37869150 http://dx.doi.org/10.3389/fneur.2023.1266778 Text en Copyright © 2023 Koohi, Male and Kaski. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Koohi, Nehzat
Male, Amanda J.
Kaski, Diego
Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
title Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
title_full Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
title_fullStr Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
title_full_unstemmed Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
title_short Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
title_sort acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585259/
https://www.ncbi.nlm.nih.gov/pubmed/37869150
http://dx.doi.org/10.3389/fneur.2023.1266778
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