AUTHOR=Koohi Nehzat , Male Amanda J. , Kaski Diego 

TITLE=Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1266778

DOI=10.3389/fneur.2023.1266778

ISSN=1664-2295

ABSTRACT=Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management.To evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo.Following routine ED care, patients with a primary complaint of dizziness, vertigo, lightheadedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analysed.Of 71 consented patients (21-91years; mean 56years, ±16.7years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (i.e., BPPV; 26-80 years; mean 48.85years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88years, mean 66years, ±12.22, 5 females), and six with central positional nystagmus (age range 23-59years, mean 41.67years, ±15.78, 6 females).Positional vertigo should be assessed with positional manoeuvres such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity.