Dia­gnostic in Patient with Acute Vertigo

Authors: J. Jeřábek
Authors‘ workplace: Neurologická klinika 2. LF UK a FN v Motole
Published in: Cesk Slov Neurol N 2015; 78/111(5): 503-509
Category: Minimonography
doi: 10.14735/amcsnn2015503


The following text summarizes management of patients with sudden vertigo. The main aim of the initial examination is to decide whether we are facing a patient with life-threatening disease, e.g. stroke, or a benign disease such as vestibular neuritis. This decision is usually made under a time pressure and knowing that neuroradiology examination may not provide sufficient information. Clinical examination of the vestibular and oculomotor function is sufficient to make the initial decision. Vestibular examination requires basic knowledge of the vestibular system function and reflex circuits involved in the organization and control of the multisensoric balance system.

Key words:
diziness – vertigo – instability – unsteadiness – head impulse test – vestibular system – stroke

The author declare he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Baloh RW. Dizzines­s in older people. J Am Geriatric Soc 1992; 40(7): 713– 721.

2. Halmagyi GM, Curthoys I. A clinical sign of canal paresis. Arch Neurol 1988; 45(7): 737– 739.

3. Longridge NS, Malinson AI. A dynamic il­legible E‑ test. A technique for as­ses­s­ing vestibule‑ ocular reflex. Acta Otolaryngol 1987; 103: 273– 279. doi: 10.3109/ 000164 88709107794.

4. Brodsky MC, Donahue SP, Vaphiades M, Brandt T. Skew deviation revis­sited. Surv Ophthalmol 2006; 51(2): 105– 128.

5. Dix MR, Hal­lpike CS. The pathology, symp­tomatology and dia­gnosis of certain com­mon disorders of vestibular system. An­n Otol Rhinol Laryngol 1952; 61(4): 987– 1016.

6. Ambler Z, Jeřábek J. Diferenciální dia­gnostika závratí. 2. vyd. Praha: Triton 2008.

7. Bronstein A, Lempert T. Dizzines­s A practical approach to dia­gnosis and management. Cambridge: University Pres­s 2007.

8. Lempert T, Neuhauser H. Epidemiology of vertigo, migraine and vestibular migraine. J Neurol 2009; 256(3): 333– 338. doi: 10.1007/ s00415‑ 009‑ 0149‑ 2.

9. Newman‑ Toker DE, Kerber KA, Yu‑ Hsiang Hsieh, Pula JH, Omron R, Saber‑ Tehrani AS et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizzenes­s. Acad Emerg Med 2013; 20(10): 987– 996. doi: 10.1111/ acem.12223.

10. Navi BB, Kamel H, Shah MP, Gros­sman AW, Wong C, Pois­son SN et al. Application of ABCD2 score to identify cerebrovascular causes of dizzines­s in the emergency department. Stroke 2012; 43(6): 1484– 1489. doi: 10.1161/ STROKEAHA.111.646414.

11. Newman­n‑Toker DE, Saber Tehrani AS, Mantokoudis G, Pula JH, Guede CI, Kerber KA et al. Quantitative video‑ oculography to help dia­gnose stroke in acute vertigo and dizzines­s: towards an ECG for the eyes. Stroke 2013; 44(4): 1158– 1161. doi: 10.1161/ STROKEAHA.111.000033.

12. Brandt T, Detrich M, Strupp M. Vertigo and dizzi­nes­s –  com­mon complaints. 2nd ed. London: Springer 2013.

13. Brandt T. Vertigo. Its multisensory syndromes. 2nd ed. New York: Springer 1999: 536.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2015 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account