Cannot miss / life threats
Cannot miss / life threats
Differential diagnosis — checklist
0/15
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Peripheral vertigo0/4
Central0/3
Presyncope0/4
Other0/4
Initial ED workup
Bedside0/5
- Orthostatic vitals
- ECG
- HINTS exam if continuous vertigo (head-impulse, nystagmus, test-of-skew)
- Dix-Hallpike if episodic
- Fingerstick glucose
Labs0/3
- CBC, BMP
- Troponin if cardiac sx
- TSH, hCG when indicated
Imaging0/2
- MRI brain (with & without contrast) w/ DWI for suspected central cause (CT misses posterior stroke)
- CTA head/neck if dissection suspected
Initial management0/3
- IV hydration
- Meclizine / antihistamine for peripheral vertigo (short course only)
- Epley maneuver for BPPV
Pearls / pitfalls
Pearls
- HINTS is more sensitive than MRI (with & without contrast) in first 48 h — but only valid if continuous vertigo with nystagmus
- Sudden hearing loss + vertigo can be AICA stroke