From the Guidelines
The diagnosis of vertigo typically involves a combination of patient history, physical examination, and specialized tests such as electronystagmography (ENG) or videonystagmography (VNG) to evaluate inner ear function and eye movements, as well as MRI or CT scans of the brain if a neurological cause is suspected. The evaluation of vertigo should start with a thorough patient history to identify the characteristics of the dizziness, including its duration, triggers, and associated symptoms such as nausea, vomiting, hearing loss, or tinnitus.
Initial Evaluation
The initial evaluation may include:
- Complete blood count (CBC) to check for anemia
- Basic metabolic panel to assess electrolyte imbalances and kidney function
- Thyroid function tests
- Blood glucose measurement Additional tests may be ordered based on the patient's specific symptoms and medical history, such as:
- Hemoglobin A1c for diabetes
- Vitamin B12 and folate levels to rule out deficiencies
- Cardiac enzymes if heart-related causes are suspected
Specialized Tests for Vertigo
For specific types of dizziness like vertigo, specialized tests may be performed, including:
- Electronystagmography (ENG) or videonystagmography (VNG) to evaluate inner ear function and eye movements
- MRI or CT scans of the brain if a neurological cause is suspected
- Audiogram to assess hearing loss
- Video- or electronystagmogram to evaluate vestibular function
- Electrocochleography to measure the electrical responses of the cochlea and auditory nerve
- Magnetic resonance imaging (MRI) of the brain to rule out central causes of vertigo, as recommended by 1.
Importance of Targeted Diagnostic Approach
A targeted diagnostic approach based on the clinical presentation is essential in evaluating vertigo, as it can stem from various systems including vestibular, cardiovascular, neurological, metabolic, or psychological origins. This approach helps to identify the underlying cause of vertigo and guide appropriate treatment, as discussed in 1.
Recent Guidelines and Recommendations
Recent guidelines and recommendations, such as those from 1 and 1, emphasize the importance of a thorough patient history, physical examination, and targeted diagnostic testing in evaluating vertigo. These guidelines also highlight the need to consider the patient's specific symptoms, medical history, and physical examination findings when selecting diagnostic tests and developing a treatment plan.
From the Research
Lab Tests for Diagnosing Vertigo
To diagnose the cause of vertigo, several lab tests and examinations can be used, including:
- Orthostatic blood pressure measurement
- Full cardiac and neurologic examination
- Assessment for nystagmus
- The Dix-Hallpike maneuver (for patients with triggered dizziness)
- The HINTS (head-impulse, nystagmus, test of skew) examination when indicated 2, 3
- Imaging studies, such as MRI or CT scans, may be ordered to rule out central causes of vertigo, such as cerebrovascular disorders or tumors 4, 3
Diagnostic Approach
The diagnostic approach to vertigo involves:
- Taking a thorough patient history to identify the timing and triggers of dizziness 2, 5
- Performing a physical examination to assess for signs of peripheral or central vertigo 2, 5
- Ordering diagnostic tests, such as lab tests or imaging studies, to rule out underlying causes of vertigo 2, 6, 4, 3
- Considering the most common causes of vertigo, such as benign paroxysmal positional vertigo and orthostatic hypotension 6
Common Causes of Vertigo
The most common causes of vertigo include: