Can emergency physicians accurately rule out a central cause of vertigo using the HINTS examination? A systematic review and meta-analysis. Ohle R, Montpellier RA, Marchadier V, et al. Clinical presentation of vertebrobasilar stroke. Vestibular migraine: how to sort it out and what to do about it. Vestibular migraine: an update on current understanding and future directions. The epidemiology of vestibular migraine: a population-based survey study. Restriction of salt, caffeine and alcohol intake for the treatment of Ménière's disease or syndrome. Therapeutic effect of steroids on vestibular neuritis: systematic review and meta-analysis. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Effect of age on treatment outcomes in benign paroxysmal positional vertigo: a systematic review. Laurent G, Vereeck L, Verbecque E, et al. Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo. Effect of vitamin D supplementation on benign paroxysmal positional vertigo recurrence: a meta-analysis. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Treatment and recurrence of traumatic versus idiopathic benign paroxysmal positional vertigo: a meta-analysis. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. ACR Appropriateness Criteria hearing loss and/or vertigo. Troponin testing and coronary syndrome in geriatric patients with nonspecific complaints: are we over-testing?. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS, STANDING, and ABCD2 tests: a diagnostic cohort study. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Antivertigo medications and drug-induced vertigo. Dizziness: approach to evaluation and management. Acute dizziness, vertigo, and unsteadiness. TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls. Saber Tehrani AS, Kattah JC, Kerber KA, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Newman-Toker DE, Cannon LM, Stofferahn ME, et al. Clinical practice guideline: Ménière's disease. Misdiagnosing dizzy patients: Common pitfalls in clinical practice. Pharmacologic intervention is limited because it often affects the ability of the central nervous system to compensate for dizziness. Other etiologies of dizziness require specific treatment to address the cause. Vestibular rehabilitation is helpful in treating many peripheral and central etiologies. Canalith repositioning procedures (e.g., Epley maneuver) are the most helpful in treating benign paroxysmal positional vertigo. The treatment for dizziness is dependent on the etiology of the symptoms. Laboratory testing and imaging are usually not required but can be helpful. The physical examination may include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver (for patients with triggered dizziness), and the HINTS (head-impulse, nystagmus, test of skew) examination when indicated. Peripheral etiologies can cause significant morbidity but are generally less concerning, whereas central etiologies are more urgent. The differential diagnosis is broad and includes peripheral and central causes. Clinicians should focus on the timing of the events and triggers of dizziness to develop a differential diagnosis because it is difficult for patients to provide quality reports of their symptoms. Dizziness is a common but often diagnostically difficult condition.
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