Patients with vestibular neuritis may have difficulty walking, but the inability to walk is a red flag for a central lesion. The neurologic examination can differentiate between benign (peripheral) and life-threatening (central) causes based on the ability to walk, type of nystagmus, results of the head impulse test, and presence of associated neurologic signs ( Table 1). General physical examination should include a thorough cardiovascular, ear, nose, throat, and neurologic examination. In BPPV, patients have no vertigo between attacks. Although changes in position worsen the vertigo in vestibular neuritis, vertigo is always present at baseline. Patients with vestibular neuritis may have difficulty standing and veer toward the affected side. Symptoms of vertigo are constant, and nausea and vomiting can be severe during the first few days. Vestibular neuritis usually has a subacute onset over several hours, peaks in intensity for 1 to 2 days, and then gradually subsides over the next few weeks. Many medications, including anticonvulsants and antihypertensives, cause dizziness.īPPV causes brief, recurrent episodes that last less than 1 minute and are brought on by changes in head movement or position. BPPV, stroke, and migraine can have a familial preponderance. A personal history of diabetes, hypertension, and hyperlipidemia are risk factors for stroke. Key questions include the frequency and duration of attacks, triggers such as positional or pressure changes, prior head trauma, associated neurologic symptoms, hearing loss, and headache. The history and physical examination are fundamental in the evaluation of vertigo. Kellerman MD, in Conn's Current Therapy 2021, 2021 Clinical Manifestations
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