Clinical and Therapeutic Aspects of Vertigo

Abstract

Abstract: Dizziness is a symptom frequently encountered in clinical practice, especially during emergency department visits and primary care visits. We can classify dizziness in one of four categories: vertigo, presyncope, disequilibrium and lightheadedness. Vertigo is the most common cause of dizziness and very often represents a diagnostic challenge for the clinician. Although appropriate clinical approach and history taking, the final diagnosis is unidentified in about 20 percent of the patients complaining of dizziness. The aim of this review is to provide an update on the main differential diagnoses of dizziness, with particular attention to the different otologic, vestibular and neurologic causes of vertigo, covering epidemiology, pathophysiology, clinical presentation, and therapy. We will discuss in detail the most common causes of vertigo, such as benign paroxysmal positional vertigo, labyrinthitis, Meniere's syndrome, vestibular neuritis, vestibular migraine and brainstem lesions. Special emphasis will be placed on the usefulness of diagnostic tests such as the Dix-Hallpike maneuver, the head impulse test and the electronystagmography. We will underline the need to perform a complete physical and neurological examination in order to correctly choose the appropriate diagnostic tests. Finally, we will review the different treatments currently available. It is extremely important to prescribe a proper treatment for dizziness, because this can dramatically improve the quality of life of these patients.