Acute Dizziness: Cases That Can’t Afford to Be Missed in the Emergency Room
Tae-Kyeong Lee, MD, PhD and Ji-Yun Park, MD
Department of Neurology, College of Medicine, Soonchunhyang University, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
ABSTRACT
Acute dizziness can be a confusing presentation in its diagnostic and managing aspects. The majority of the presenting cases in the emergency department are the benign peripheral vestibular disorders. However, some of the central vestibular disorders can appear to be quite similar to benign peripheral disorders. Therefore, physicians should be able to recognize‘ red flags’ which imply lifethreatening central disorders. The most important central disorders masquerading a peripheral one are cerebellar strokes which present acute isolated dizziness without long tract sign. Among them,‘ pseudovestibular neuritis’ from acute infarction in the medial branch of the posterior inferior cerebellar artery (mPICA),‘ psudolabyrintitis’ from anterior inferior cerebellar artery (AICA) infarction,‘ pseudo-benign paroxysmal positional vertigo (BPPV)’ from cerebellar vermal infarction, and transient ischemic attack from vertebrobasilar insufficiency occasionally harass emergency physicians. Common benign peripheral disorders have unique clinical features allowing for bedside diagnosis. Therefore, if the presentation is not typical for a peripheral vestibular disorder, the possibility of the central disorder should be considered. The patterns of nystagmus, head thrust test, head shaking test, severity of imbalance, and presence of cerebrovascular risk factors can provide the key information for distinguishing benign peripheral causes from sinister central disorders. In this paper, case-oriented differential diagnosis of central and peripheral vestibular disorders was discussed.
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