Dizziness and Vertigo Evaluation

Classification and Symptoms

The American College of Radiology recommends classifying dizziness into four main categories: vertigo, disequilibrium, presyncope, and lightheadedness 1, 2
Vertigo is characterized by a false sense of spinning or rotation, indicating a problem with the inner ear or central nervous system 3, 1
The American Academy of Otolaryngology-Head and Neck Surgery suggests that vertigo can be confirmed by asking patients if they feel like they or their surroundings are spinning 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends identifying triggers, such as head position, and associated symptoms, like otologic or neurological symptoms 3, 4
The Dix-Hallpike maneuver is used to diagnose posterior canal BPPV, with a characteristic torsional, upbeating nystagmus 4
The HINTS examination is used to differentiate between central and peripheral causes, with central causes indicating a higher risk of stroke 5

The American College of Radiology recommends that imaging is not necessary for typical BPPV with a positive Dix-Hallpike test 4
Brain imaging, preferably MRI with diffusion-weighted imaging, is necessary for patients with focal neurological deficits, atypical nystagmus patterns, or no improvement with treatment 5, 4
The Epley maneuver is the treatment of choice for BPPV, with a 90-98% success rate when performed correctly 4
Patient education is crucial, including information on BPPV recurrence, fall risk, and the importance of reporting atypical symptoms 4