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Approach to Dizziness/Vertigo in Adults (Duration < 2 Weeks)
Approach to Dizziness/Vertigo in Adults (Duration < 2 Weeks)
Use this guide when symptoms have lasted less than 2 weeks and no obvious medical cause is identified.
Common symptoms include:
Dizziness or vertigo
Nausea, vomiting
Nystagmus
Postural instability
Tip: If you're uncertain about the timing or triggers, use the STANDING protocol.
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
Key Vestibular Syndromes
Key Vestibular Syndromes
Acute Vestibular Syndrome (AVS)
Acute Vestibular Syndrome (AVS)
Duration: Days to weeks
Symptomatic even at rest
Worsened by head movement or position change
Spontaneous Episodic Vestibular Syndrome (s-EVS)
Spontaneous Episodic Vestibular Syndrome (s-EVS)
Duration: Minutes to hours
Recurrent attacks (but may be first presentation)
No clear triggers, though movement may worsen symptoms
Asymptomatic at rest
If uncertain, treat as AVS
Triggered Episodic Vestibular Syndrome
Triggered Episodic Vestibular Syndrome
(t-EVS)
(t-EVS)
Duration: Seconds to minutes
Recurrent, triggered by head movement
Asymptomatic at rest, symptoms provoked by triggers
COMMON NYSTAGMUS PATTERNS
COMMON NYSTAGMUS PATTERNS
Diagnostic Approach
Diagnostic Approach
General Approach (All Patients)
General Approach (All Patients)
Full neurologic exam:
Cranial nerves
Reflexes
Gait assessment
Cerebellar function
Look for medical causes (e.g., anemia, hypoglycemia, dehydration, medications)
Based on Syndrome Type
Based on Syndrome Type
AVS
Use HINTS exam + hearing assessment
s-EVS
Focus on history, gait exam, and general neurological assessment
Consider HINTS + hearing exam
t-EVS
Use Dix-Hallpike (for posterior canal BPPV)
If horizontal nystagmus, perform supine roll test
Special Note on bppv
Special Note on bppv
Posterior canal BPPV: Upbeat, torsional nystagmus on Dix-Hallpike
Horizontal canal BPPV: Horizontal nystagmus →
Do supine roll test
Treat with Gufoni maneuver or Lempert (barbecue) roll
Reference
Reference
SAEM GRACE-3 Dizziness Clinical Practice Guideline
CONTRIBUTORS:
Author: Dr Faysal Subhani
Editor: Dr Ayesha Saeed
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