The Spins: A Systematic Approach to Undifferentiated Vertigo

Vertigo, or dizziness, is a common complaint in the primary care setting. The one-year prevalence of these complaints in the general population is approximately 5%, but approaches 30% in patients at least 60 years of age. While peripheral vestibular dysfunction is the most common cause of dizziness, it may be the initial presenting sign of a potentially devastating central cause such as cerebellar or brainstem stroke. The differentiation of these diagnoses can be daunting. A general understanding of the different presentations of central versus peripheral vertigo, historical context and timing, and physical exam findings, can facilitate a diagnosis. For example, prolonged and constant non-positional vertigo is unlikely to be benign paroxysmal positional vertigo, but the absence of ataxia or other neurologic findings makes it unlikely to be a stroke. Understanding the pathophysiology of the common causes of vertigo, along with a straightforward approach, can simplify management and referral decisions.