The diagnosis of vertigo is most often made based upon history and clinical presentation. If the patient is experiencing a spinning sensation that worsens by a change in position, and lessens by lying still, the health care practitioner can confirm the cause of dizziness as vertigo.
Further history may be taken to make certain that the symptom of vertigo is isolated to an inner ear condition and not due to a problem in the brain (for example, a stroke).
Physical examination will focus on the neurologic examination and may involve looking at eye movements. With vertigo, nystagmus may be present. This is an involuntary movement of the eyes, slow and smooth in one direction with fast twitches in the other. It is the eyes' attempt to compensate for the abnormal signals being created in the inner ear.
The patient's hearing may be tested to assess potential hearing loss. This may be seen in Meniere's Disease or with an acoustic neuroma, but not necessarily with labyrinthitis or benign positional vertigo.
The rest of the neurologic examination may be done to look for one-sided weakness, loss of coordination, or loss of balance as potential signs of stroke.
Evaluation for BPPV or labyrinthitis is often complete at this point, although depending upon the health care practitioner's concerns, further testing may be indicated. Referral may be made to a physical therapist specially trained in vestibular therapy.
If there is confusion as to the potential cause of vertigo, imaging of the brain may be needed. Magnetic resonance imaging (MRI) may be indicated since this test evaluates the cerebellum more accurately. Computerized tomography (CT scan) may be used in an emergency to assess bleeding.
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Archived: March 20, 2014
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