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General Neurology

Vertigo

Peripheral vs central — HINTS and when to image

Vertigo is peripheral (labyrinth, vestibular nerve) or central (brainstem, cerebellum). Acute, persistent vertigo with nausea and nystagmus: rule out stroke with HINTS.

1.Peripheral vs Central

Peripheral: vestibular neuritis, BPPV, Meniere's. Central: stroke (AICA/PICA), MS, mass. HINTS helps distinguish.[+]

2.HINTS

Head impulse normal → peripheral; abnormal → central. Nystagmus direction-changing or vertical → central. Skew → central. Plus: hearing loss + vascular risk → stroke. One central finding: image.[+]

3.Imaging and Workup

MRI brain with DWI for stroke; CT insufficient. Audiometry if hearing loss. Dix-Hallpike for BPPV.[+]

4.BPPV

BPPV: brief, positional. Dix-Hallpike; Epley for posterior canal. Horizontal: roll.[+]

Tap underlined terms for details · Tap [+] to expand

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