Dizziness (Dizzy)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Balance Disorders: Vertigo, Migraines, Motion Sickness and More

Quick GuideBalance Disorders: Vertigo, Motion Sickness, Labyrinthitis, and More

Balance Disorders: Vertigo, Motion Sickness, Labyrinthitis, and More

How is vertigo diagnosed?

The diagnosis of vertigo is most often made based upon history and clinical presentation. If the patient is experiencing a spinning sensation that worsens by a change in position, and lessens by lying still, the health care professional can confirm the cause of dizziness as vertigo if there are appropriate findings on physical examination.

Further history may be taken to make certain that the symptom of vertigo is isolated to an inner ear condition and not due to a problem in the brain (for example, a stroke).

Neurological examination

Physical examination will focus on the neurologic examination and may involve looking at eye movements. With vertigo, nystagmus may be present. This is an involuntary movement of the eyes, slow and smooth in one direction with fast twitches in the other. It is the eyes' attempt to compensate for the abnormal signals being created in the inner ear. The patient may be asked to lay flat or sit upright to uncover the presence of nystagmus.

The patient's hearing may be tested to assess potential hearing loss. This may be seen in Meniere's disease or with an acoustic neuroma, but not necessarily with labyrinthitis or benign positional vertigo.

The rest of the neurologic examination may be done to look for one-sided weakness, loss of coordination, or loss of balance as potential signs of stroke.

Evaluation for BPPV or labyrinthitis is often complete at this point, although depending upon the health care professional's concerns, further testing may be indicated. Referral may be made to a physical therapist specially trained in vestibular therapy for diagnosis confirmation and symptom relief.

If there is confusion as to the potential cause of vertigo, imaging of the brain may be needed. Magnetic resonance imaging (MRI) may be indicated since this test evaluates the cerebellum more accurately. Computerized tomography (CT scan) may be used in an emergency to look for bleeding in the brain.

Medically Reviewed by a Doctor on 3/27/2015

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