Skip to content

Vertigo / Dizziness Evaluation

VERSION: 1.0 CREATED: January 27, 2026 STATUS: Approved


DIAGNOSIS: Vertigo / Dizziness Evaluation

ICD-10: R42 (Dizziness and giddiness), H81.10 (Benign paroxysmal positional vertigo, unspecified ear), H81.00 (Meniere's disease, unspecified ear), H81.30 (Other peripheral vertigo, unspecified ear), H81.390 (Other peripheral vertigo, unspecified ear), G45.0 (Vertebro-basilar artery syndrome), H81.4 (Vertigo of central origin), H83.09 (Labyrinthitis, unspecified ear)

CPT CODES: 82947 (Blood glucose), 85025 (CBC), 80053 (CMP), 84443 (TSH), 93000 (ECG (12-lead)), 80061 (Lipid panel), 83036 (HbA1c), 86592 (RPR / VDRL), 82607 (Vitamin B12), 82728 (Ferritin), 86235 (ANA), 86618 (Lyme serology), 70450 (CT head without contrast), 70551 (MRI brain with DWI), 70544 (MRA head), 95992 (Dix-Hallpike maneuver), 92557 (Audiometry), 93306 (Echocardiogram (TTE)), 93224 (Holter), 93880 (Carotid ultrasound), 92540 (Videonystagmography (VNG)), 92517 (Vestibular evoked myogenic potentials (VEMP)), 70480 (High-resolution CT temporal bones), 95924 (Tilt table testing)

SYNONYMS: Vertigo, dizziness, lightheadedness, light headedness, disequilibrium, presyncope, room spinning, BPPV, benign paroxysmal positional vertigo, vestibular neuritis, labyrinthitis, Meniere disease, Meniere's disease, imbalance, unsteadiness, giddiness, vestibular migraine

SCOPE: Evaluation and management of acute vertigo and dizziness in adults. Covers differentiation of peripheral vs. central causes, the HINTS exam, Dix-Hallpike and canalith repositioning maneuvers, evaluation for posterior circulation stroke, and management of common vestibular disorders (BPPV, vestibular neuritis, Meniere's disease, vestibular migraine). Excludes chronic non-specific dizziness (persistent postural-perceptual dizziness), medication-induced dizziness (covered briefly), and presyncope/orthostatic hypotension (separate evaluation).


PRIORITY KEY: STAT = Immediate | URGENT = Within hours | ROUTINE = Standard | EXT = Extended/atypical cases | - = Not applicable to this setting

═══════════════════════════════════════════════════════════════ SECTION A: ACTION ITEMS ═══════════════════════════════════════════════════════════════

1. LABORATORY WORKUP

1A. Essential/Core Labs

Test ED HOSP OPD ICU Rationale Target Finding
Blood glucose (CPT 82947) STAT STAT ROUTINE STAT Hypoglycemia can cause dizziness/lightheadedness; hyperglycemia (diabetic neuropathy); metabolic dizziness 70-180 mg/dL; hypo/hyperglycemia → correct and reassess
CBC (CPT 85025) STAT STAT ROUTINE STAT Anemia (lightheadedness, presyncope); infection (labyrinthitis); baseline Normal; anemia (Hgb <10) can cause dizziness; infection markers
CMP (CPT 80053) (BMP + LFTs) STAT STAT ROUTINE STAT Electrolyte abnormalities (hyponatremia, hypoglycemia); renal dysfunction; dehydration Normal; hyponatremia <130 can cause neurologic symptoms including imbalance
TSH (CPT 84443) - ROUTINE ROUTINE - Thyroid dysfunction can cause dizziness/imbalance; hyperthyroidism especially Normal; abnormal → thyroid evaluation
ECG (12-lead) (CPT 93000) STAT STAT ROUTINE STAT Cardiac arrhythmia causing presyncope/dizziness; differentiates cardiac from vestibular Normal; arrhythmia → cardiac workup; prolonged QTc
Orthostatic vital signs STAT STAT ROUTINE STAT Orthostatic hypotension is common cause of dizziness, especially in elderly; drop in SBP >20 or DBP >10 with symptoms No orthostatic drop; positive orthostatics → volume status, medication review, autonomic evaluation

1B. Extended Workup (Second-line)

Test ED HOSP OPD ICU Rationale Target Finding
Lipid panel (CPT 80061) - ROUTINE ROUTINE - Vascular risk factors if central cause suspected; stroke risk stratification LDL <70 (high risk) or <100; triglycerides; HDL
HbA1c (CPT 83036) - ROUTINE ROUTINE - Diabetes (vascular risk factor; diabetic neuropathy affecting balance) <7.0%; elevated → diabetes management
RPR / VDRL (CPT 86592) - - ROUTINE - Neurosyphilis (rare cause of vertigo, especially in HIV); otosyphilis Negative; positive → CSF analysis, penicillin treatment
Vitamin B12 (CPT 82607) - ROUTINE ROUTINE - B12 deficiency causes peripheral neuropathy and imbalance; subacute combined degeneration >300 pg/mL; low → supplement and monitor
Ferritin (CPT 82728) - ROUTINE ROUTINE - Iron deficiency (even without anemia) can cause dizziness >50 ng/mL; low → iron supplementation
ANA (CPT 86235) / ESR (CPT 85652) / CRP (CPT 86140) - ROUTINE ROUTINE - Autoimmune inner ear disease; vasculitis (CNS vasculitis affecting posterior circulation) Normal; elevated → autoimmune/inflammatory workup
Drug levels (if applicable) STAT STAT ROUTINE STAT Ototoxic medications (aminoglycosides, salicylates); anticonvulsant toxicity (phenytoin, carbamazepine) Therapeutic; toxic levels → adjust or discontinue

1C. Rare/Specialized (Refractory or Atypical)

Test ED HOSP OPD ICU Rationale Target Finding
FTA-ABS - - ROUTINE - Confirmatory for syphilis if RPR positive; otosyphilis/neurosyphilis Negative
Lyme serology (CPT 86618) - - ROUTINE - Lyme disease can cause cranial neuropathies, including vestibular neuritis; endemic areas Negative; positive → Western blot confirmation
Anti-GAD65 antibodies - - EXT - Cerebellar ataxia; autoimmune cerebellitis Negative; positive → autoimmune cerebellar disease
Paraneoplastic antibody panel - - EXT - Paraneoplastic cerebellar degeneration (anti-Yo, anti-Hu); subacute ataxia with vertigo Negative; positive → malignancy search
CSF analysis - EXT EXT - If infectious, inflammatory, or neoplastic cause suspected; normal in peripheral vestibular disorders Normal; pleocytosis → infection/inflammation; protein elevation
Genetic testing - - EXT - Familial episodic ataxia; spinocerebellar ataxia; hereditary vestibular disorders Specific mutations (CACNA1A for EA2; SCA genes)

2. DIAGNOSTIC IMAGING & STUDIES

2A. Essential/First-line

Study ED HOSP OPD ICU Timing Target Finding Contraindications
HINTS exam (Head Impulse, Nystagmus, Test of Skew) STAT STAT ROUTINE STAT CRITICAL bedside exam; must be performed in patient with ACUTE VESTIBULAR SYNDROME (continuous vertigo, nausea, nystagmus, gait instability); performed by trained examiner; more sensitive than early MRI for stroke Peripheral pattern (benign): Positive head impulse (catch-up saccade), horizontal nystagmus with unidirectional fast phase, no skew deviation; Central pattern (concerning for stroke): Negative/normal head impulse, direction-changing or vertical nystagmus, skew deviation Cannot perform if patient not having acute continuous vertigo; requires examiner training
CT head without contrast (CPT 70450) STAT STAT - STAT NOT sensitive for posterior fossa stroke (sensitivity ~20-40%); useful for hemorrhage; may be appropriate for trauma or if MRI not available; does NOT rule out posterior circulation stroke Cerebellar or brainstem hemorrhage; mass lesion; hydrocephalus; NEGATIVE CT does NOT exclude stroke in posterior circulation None for non-contrast
MRI brain with DWI (CPT 70551) URGENT URGENT ROUTINE URGENT Gold standard for posterior circulation stroke; DWI highly sensitive for acute ischemia; HOWEVER: Early MRI (<48h) can miss 12-20% of small posterior fossa strokes — clinical (HINTS) may be more sensitive; repeat MRI if high suspicion and initial negative Acute infarction (restricted diffusion); brainstem lesion; cerebellar lesion; MS plaque; tumor; vestibular schwannoma MRI-incompatible implants; severe claustrophobia
MRA head (CPT 70544) and neck (CPT 70547) (or CTA head (CPT 70496) / neck (CPT 70498)) URGENT URGENT ROUTINE URGENT If central cause suspected; vertebral artery dissection; basilar artery stenosis; vertebrobasilar insufficiency Vertebral artery dissection; stenosis; occlusion; aneurysm MRA: same as MRI; CTA: contrast allergy, renal impairment

2B. Extended

Study ED HOSP OPD ICU Timing Target Finding Contraindications
Dix-Hallpike maneuver (CPT 95992) STAT STAT ROUTINE STAT Diagnostic for BPPV (posterior canal, most common); performed on ALL patients with episodic positional vertigo; positive if nystagmus and vertigo provoked with latency and limited duration Positive: Upbeating-torsional nystagmus toward affected ear, 2-20 sec latency, <60 sec duration, fatigable with repetition = posterior canal BPPV Cervical spine disease/instability (modify technique); carotid stenosis (theoretical)
Supine roll test (Pagnini-McClure) STAT STAT ROUTINE STAT Diagnostic for horizontal canal BPPV; patient supine, rapidly turn head 90° to each side; geotropic (toward ground) or apogeotropic (away from ground) horizontal nystagmus Horizontal nystagmus provoked by head turning; geotropic (canalithiasis) vs. apogeotropic (cupulolithiasis) Same as Dix-Hallpike
Audiometry (CPT 92557) - URGENT ROUTINE - Essential if hearing loss suspected (Meniere's disease, labyrinthitis, vestibular schwannoma); sudden sensorineural hearing loss is emergency Meniere's: low-frequency sensorineural hearing loss; Schwannoma: asymmetric sensorineural hearing loss; Labyrinthitis: hearing loss + vertigo Patient cooperation
Echocardiogram (TTE) (CPT 93306) ± TEE - URGENT ROUTINE - If cardioembolic source suspected for stroke; PFO evaluation; valvular disease PFO; valve vegetations; thrombus; cardiomyopathy None (TTE); TEE: esophageal pathology
Holter (CPT 93224) / Event monitor (CPT 93268) - ROUTINE ROUTINE - If paroxysmal arrhythmia suspected as cause of dizziness; palpitations with dizziness Arrhythmia during symptoms None
Carotid ultrasound (CPT 93880) - ROUTINE ROUTINE - Carotid stenosis (though carotid disease rarely causes isolated vertigo without other symptoms) Stenosis; plaque None

2C. Rare/Advanced

Study ED HOSP OPD ICU Timing Target Finding Contraindications
Videonystagmography (VNG) (CPT 92540) / Electronystagmography (ENG) (CPT 92540) - - ROUTINE - Quantitative vestibular function testing; caloric testing (ice water or warm/cool air); localizes peripheral lesion; documents vestibular hypofunction Unilateral weakness on calorics (peripheral lesion); central patterns Perforated TM (water calorics)
Video head impulse test (vHIT) - - ROUTINE - Quantitative bedside test of vestibulo-ocular reflex; tests individual semicircular canals; more sensitive than bedside HIT Reduced VOR gain; covert/overt saccades; identifies affected canal Specialized equipment
Vestibular evoked myogenic potentials (VEMP) (CPT 92517) - - ROUTINE - Tests saccule (cVEMP) and utricle (oVEMP); superior semicircular canal dehiscence; Meniere's Abnormal in superior canal dehiscence; saccular dysfunction Hearing loss affects testing
Rotary chair testing - - EXT - Quantitative VOR assessment; bilateral vestibular hypofunction Bilateral vestibular loss; gain/phase abnormalities Specialized facility
High-resolution CT temporal bones (CPT 70480) - - ROUTINE - Superior semicircular canal dehiscence; cholesteatoma; temporal bone abnormality Dehiscence of superior canal; bony erosion Radiation
Electrocochleography (ECoG) - - EXT - Meniere's disease confirmation; endolymphatic hydrops Elevated SP/AP ratio in Meniere's Requires audiologist

Lumbar Puncture

Study ED HOSP OPD ICU Timing Target Finding Contraindications
LP — Generally NOT indicated - EXT EXT - NOT routinely indicated for peripheral vestibular disorders; consider if meningitis, MS, CNS vasculitis, or leptomeningeal disease suspected Normal in BPPV, vestibular neuritis, Meniere's; abnormal → specific CNS pathology Posterior fossa mass; elevated ICP

3. TREATMENT PROTOCOLS

3A. Acute/Emergent Treatment

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Symptomatic relief (vestibular suppressants) IV - 25-50 mg :: IV :: q6h :: Acute severe vertigo: Meclizine 25-50 mg PO q6-8h; OR Dimenhydrinate (Dramamine) 50 mg PO/IV q6h; OR Promethazine 25 mg PO/IM/IV q6h; OR Ondansetron 4-8 mg IV/PO q8h (for nausea); IV fluids for dehydration from vomiting; Diazepam 2-5 mg IV/PO for severe acute vertigo (benzodiazepines are potent vestibular suppressants) - Short-term use only (24-72h); vestibular suppressants interfere with central compensation if used chronically; avoid in suspected central cause until stroke ruled out STAT STAT ROUTINE STAT
IV fluids IV - N/A :: IV :: per protocol :: If dehydrated from vomiting; NS or LR bolus then maintenance; assess orthostatic hypotension - Supportive care; correct volume depletion STAT STAT - STAT
Antiemetics IV - 4-8 mg :: IV :: - :: Ondansetron 4-8 mg IV/PO; metoclopramide 10 mg IV (avoid in elderly — EPS); prochlorperazine 5-10 mg IV/IM - Nausea is often the most debilitating symptom STAT STAT ROUTINE STAT
Rule out stroke - - N/A :: - :: per protocol :: If ANY central features on HINTS: STAT MRI with DWI; vascular imaging (MRA or CTA); neurology/stroke consultation; Central features: Normal/negative head impulse test, vertical or direction-changing nystagmus, skew deviation, focal neurologic signs, severe imbalance (cannot walk), hearing loss + vertigo without Meniere's history - HINTS is more sensitive than early CT or MRI for posterior circulation stroke; do NOT rely on negative CT to exclude stroke STAT STAT - STAT
Epley maneuver (canalith repositioning) (CPT 95992) - - 90% :: - :: - :: For BPPV (positive Dix-Hallpike): Immediately perform Epley maneuver; highly effective (80-90% single treatment); may repeat if symptoms persist; send home with instructions for home Epley or Brandt-Daroff exercises - Epley is definitive treatment for posterior canal BPPV; medications are NOT indicated for BPPV — repositioning maneuvers are the treatment STAT STAT ROUTINE STAT

3B. Disease-Specific Treatment

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Epley maneuver (posterior canal) - - N/A :: - :: per session :: Standard canalith repositioning; patient starts seated, Dix-Hallpike position for 30 sec, rotate head 90° toward opposite side (30 sec), roll body to face down with head still turned (30 sec), sit up; NNT = 2-3 for resolution - First-line treatment for posterior canal BPPV; highly effective; may repeat same day or next visit - - - -
Semont maneuver (alternative) - - N/A :: - :: per session :: Alternative to Epley; patient moved rapidly from side to side; less commonly used but effective - Alternative if Epley difficult or ineffective - - - -
BBQ roll (Lempert maneuver) — horizontal canal - - N/A :: - :: per session :: For horizontal canal BPPV; patient rotates 360° along long axis of body (log roll) toward unaffected side; 90° increments with 30 sec pauses - Treatment for horizontal canal BPPV; geotropic variant - - - -
Brandt-Daroff exercises (home) - - N/A :: - :: per session :: Patient alternates lying on each side x 30 sec, 10-20 repetitions, 3x daily; habituates symptoms; less effective than Epley for posterior canal - Adjunctive home therapy; may help with residual symptoms; promotes compensation - - - -
Avoid vestibular suppressants for BPPV - - N/A :: - :: N/A :: Do NOT prescribe meclizine for ongoing BPPV treatment; medications delay compensation and do not address the mechanical problem - BPPV is a mechanical problem (otoliths); repositioning is definitive treatment - - - -
Post-treatment instructions - - N/A :: - :: once :: Avoid lying flat for 1-2 nights (sleep propped up); avoid rapid head movements for 24-48h; avoid affected side lying for 1 week (controversial but commonly recommended) - Reduces immediate recurrence; evidence is mixed - - - -

VESTIBULAR NEURITIS / LABYRINTHITIS

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Corticosteroids - - 1 mg/kg :: - :: daily x 10 days :: Prednisone 1 mg/kg/day (max 60 mg) x 10 days with taper OR methylprednisolone 100 mg x 3 days then taper; start within 72 hours of symptom onset for best benefit - Strupp et al. (2004): Steroids improve vestibular function recovery in vestibular neuritis; start early; NNT ~4 for complete recovery - - - -
Antivirals (controversial) PO - 1000 mg :: PO :: TID :: Valacyclovir 1000 mg TID x 7 days; evidence is WEAK; some use empirically if early presentation; thought to be HSV reactivation (like Bell's palsy) - Cochrane review: No clear benefit; some clinicians still use empirically, especially if labyrinthitis with hearing loss - - - -
Vestibular suppressants (short-term only) PO - 25 mg :: PO :: q8h :: Meclizine 25 mg q8h OR dimenhydrinate 50 mg q6h OR diazepam 5 mg BID x 1-3 days ONLY; taper off as soon as tolerated - Short-term symptom relief; STOP after 72 hours maximum — prolonged use delays compensation - - - -
Early vestibular rehabilitation - - N/A :: - :: daily :: Refer to vestibular physical therapy; gaze stabilization exercises; balance training; habituation exercises; START EARLY (as soon as acute symptoms controlled) - Cochrane review: Vestibular rehabilitation is effective for unilateral vestibular hypofunction; early initiation improves outcomes - - - -
Education - - N/A :: - :: once :: Explain natural history (acute symptoms resolve over days to weeks; full compensation may take weeks to months); reassurance; avoid prolonged bed rest - Reduce anxiety; promote activity and compensation - - - -

MENIERE'S DISEASE

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Dietary modification PO - 1500-2000 mg/day :: PO :: - :: Low sodium diet (<1500-2000 mg/day); limit caffeine and alcohol; regular meals; avoid MSG - First-line lifestyle modification; reduces endolymphatic hydrops; evidence is limited but widely recommended - - - -
Diuretics - - 25-50 mg :: - :: daily :: Hydrochlorothiazide 25-50 mg daily OR hydrochlorothiazide/triamterene (Dyazide, Maxzide); acetazolamide 250 mg BID as alternative - Reduces endolymph volume; widely used despite limited RCT evidence - - - -
Betahistine - - 16-24 mg :: - :: TID :: 16-24 mg TID (not available in US; available in Europe, Canada); H1 agonist/H3 antagonist; improves cochlear blood flow - Commonly used in Europe; evidence mixed; may reduce attack frequency - - - -
Intratympanic gentamicin - - N/A :: - :: once :: Chemical vestibular ablation; destroys vestibular hair cells; reduces vertigo attacks but risks hearing loss; for refractory unilateral disease - Effective for vertigo control (>80%); risk of hearing loss (10-30%); used for refractory cases - - - -
Intratympanic steroids - - N/A :: - :: once :: Dexamethasone intratympanic injection; may reduce attacks; less destructive than gentamicin - Alternative to gentamicin; preserves hearing; less consistent efficacy - - - -
Endolymphatic sac surgery - - N/A :: - :: once :: Surgical decompression of endolymphatic sac; evidence is debated; some benefit in select patients - Controversial; Cochrane review shows limited evidence; considered for refractory cases - - - -
Vestibular nerve section / Labyrinthectomy - - N/A :: - :: once :: Surgical destruction of vestibular nerve (preserves hearing) or entire labyrinth (destroys hearing); for refractory unilateral disease - Last resort; highly effective for vertigo; significant surgery - - - -

VESTIBULAR MIGRAINE

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Migraine lifestyle modifications - - N/A :: - :: daily :: Regular sleep; hydration; avoid triggers (specific to patient); regular meals; stress management - Baseline management for all migraine - - - -
Acute treatment SC - 50-100 mg :: SC :: - :: Triptans (sumatriptan 50-100 mg PO, 6 mg SQ); NSAIDs; antiemetics (ondansetron, metoclopramide); vestibular suppressants for vertigo component - Standard migraine abortive therapy; triptans can help vestibular symptoms - - - -
Preventive therapy - - 40-160 mg :: - :: daily :: Beta-blockers: Propranolol 40-160 mg daily; metoprolol 50-200 mg daily; TCAs: Amitriptyline 10-75 mg HS; nortriptyline; Anticonvulsants: Topiramate 25-100 mg BID; valproate; SNRIs: Venlafaxine 37.5-150 mg daily; Other: CGRP antagonists (emerging); verapamil - Same preventive agents as migraine; choose based on comorbidities (e.g., depression → amitriptyline; hypertension → beta-blocker) - - - -
Vestibular rehabilitation - - N/A :: - :: daily :: Helpful for chronic vestibular symptoms between attacks; balance training; habituation - May improve chronic symptoms and disability - - - -

CENTRAL CAUSES (Posterior Circulation Stroke)

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Stroke protocol IV - N/A :: IV :: per protocol :: If central cause suspected or identified: acute stroke protocol; consider IV thrombolysis (tPA/tenecteplase) if within window; endovascular therapy for basilar artery occlusion; aspirin if not tPA candidate; admit to stroke unit - Posterior circulation stroke is life-threatening; basilar artery occlusion has >80% mortality if untreated - - - -
Secondary stroke prevention - - N/A :: - :: daily :: Dual antiplatelet therapy (aspirin + clopidogrel x 21 days per CHANCE/POINT); statin; BP control; diabetes management; address vascular risk factors - Per acute ischemic stroke guidelines - - - -
Anticoagulation (if indicated) - - N/A :: - :: per protocol :: If vertebral artery dissection or cardiac source (atrial fibrillation, PFO with high-risk features) - Per stroke etiology - - - -

3C. Medications to AVOID or Use with Caution

Treatment Route Indication Dosing Contraindications Monitoring ED HOSP OPD ICU
Vestibular suppressants (prolonged use) - - - - - - - - -
Ototoxic medications (aminoglycosides, loop diuretics, salicylates, cisplatin) - - - - - - - - -
Alcohol - - - - - - - - -
Benzodiazepines (chronic use) - - - - - - - - -
CNS depressants - - - - - - - - -
Medications causing orthostatic hypotension (antihypertensives, alpha-blockers, diuretics) - - - - - - - - -

4. OTHER RECOMMENDATIONS

4A. Essential

Recommendation ED HOSP OPD ICU Details
HINTS exam (if acute vestibular syndrome) STAT STAT - STAT Must be performed by trained examiner in patient with CONTINUOUS vertigo and nystagmus; more sensitive than CT/early MRI for stroke; see HINTS protocol in appendix
Dix-Hallpike maneuver STAT STAT ROUTINE STAT Perform on ALL patients with EPISODIC POSITIONAL vertigo; diagnostic for BPPV; if positive → Epley maneuver
Neurology consultation - URGENT ROUTINE URGENT If central cause suspected; diagnostic uncertainty; refractory symptoms; atypical features
Stroke consultation STAT STAT - STAT If HINTS suggests central cause; any concern for posterior circulation stroke
Otolaryngology / Neurotology referral - ROUTINE ROUTINE - Meniere's disease; recurrent BPPV; hearing loss; intratympanic therapy consideration
Vestibular rehabilitation referral - ROUTINE ROUTINE - ALL patients with vestibular hypofunction (vestibular neuritis); chronic dizziness; BPPV with residual imbalance
Driving restrictions - ROUTINE ROUTINE - Do not drive during acute vertigo; clear when symptoms resolved; assess on case-by-case basis
Fall precautions STAT STAT ROUTINE STAT Acute vertigo = high fall risk; assist with ambulation; home safety assessment

4B. Extended

Recommendation ED HOSP OPD ICU Details
Audiometry - URGENT ROUTINE - If hearing loss (Meniere's, labyrinthitis, vestibular schwannoma); sudden sensorineural hearing loss is emergency (steroids within 48h)
Cardiology referral - ROUTINE ROUTINE - If cardiac arrhythmia suspected; palpitations with dizziness; syncope
Psychiatry / Psychology - ROUTINE ROUTINE - Anxiety disorders commonly cause dizziness; panic disorder; persistent postural-perceptual dizziness (PPPD); CBT effective
Physical therapy (vestibular) - ROUTINE ROUTINE - Vestibular rehabilitation therapy (VRT); gaze stabilization; balance training; habituation; evidence-based and highly effective
Sleep medicine - - ROUTINE - If sleep disorder contributing (sleep apnea, circadian disruption)
Headache specialist / Neurology - - ROUTINE - If vestibular migraine suspected; frequent migrainous vertigo

4C. Atypical/Refractory

Recommendation ED HOSP OPD ICU Details
Video-EEG monitoring - - EXT - If seizure (vestibular aura) suspected; temporal lobe epilepsy can cause vertigo/dizziness
Tilt table testing (CPT 95924) - - ROUTINE - If neurally-mediated syncope or POTS suspected; recurrent presyncope
Neuropsychological testing - - EXT - If cognitive component suspected; anxiety/depression contributing
Superior canal dehiscence workup - - ROUTINE - If sound-induced or pressure-induced vertigo (Tullio phenomenon, Hennebert sign); CT temporal bones; VEMP
Autoimmune inner ear disease workup - - ROUTINE - If bilateral vestibular loss, bilateral hearing loss, or systemic autoimmune features; steroids trial
Perilymphatic fistula evaluation - - EXT - If trauma-associated vertigo/hearing loss; exploratory tympanotomy if suspected

═══════════════════════════════════════════════════════════════ SECTION B: SUPPORTING INFORMATION ═══════════════════════════════════════════════════════════════

5. DIFFERENTIAL DIAGNOSIS

Dizziness Classification

Type Description Common Causes
Vertigo Illusion of movement (usually spinning); room spinning or self-spinning BPPV, vestibular neuritis, Meniere's disease, vestibular migraine, posterior circulation stroke
Presyncope / Lightheadedness Feeling of impending faint; "graying out" Orthostatic hypotension, cardiac arrhythmia, vasovagal syncope, dehydration
Disequilibrium / Imbalance Unsteadiness; difficulty walking; feeling off-balance without spinning Peripheral neuropathy, cerebellar disorders, bilateral vestibular loss, Parkinson's disease, cervical spondylosis
Non-specific dizziness Vague lightheadedness, floating, difficulty concentrating Anxiety/panic disorder, depression, hyperventilation, medication side effects, PPPD

Peripheral vs. Central Vertigo

Feature Peripheral Central
Onset Sudden Sudden or gradual
Severity Often severe; patient feels terrible Variable; may be mild
Nystagmus Unidirectional, horizontal-torsional; suppressed by visual fixation Direction-changing, vertical, or purely torsional; NOT suppressed by fixation
Head impulse test Abnormal (catch-up saccade) Normal (no saccade)
Skew deviation Absent May be present
Hearing loss May have (labyrinthitis, Meniere's) Rare (unless AICA stroke)
Other neuro signs Absent May have (diplopia, dysarthria, ataxia, weakness, numbness)
Gait Can usually walk (with difficulty) May be unable to walk (severe ataxia)
Imbalance severity Moderate Severe (falling toward one side)
Associated symptoms Nausea/vomiting (severe); tinnitus; ear fullness (Meniere's) Headache (dissection, migraine); diplopia; dysphagia; limb weakness/numbness

HINTS Exam Interpretation

Component Peripheral (Safe) Pattern Central (Dangerous) Pattern
Head Impulse ABNORMAL (corrective saccade) NORMAL (no saccade)
Nystagmus Unidirectional (fast phase always beats same direction) Direction-changing (beats right on right gaze, left on left gaze) OR vertical OR purely torsional
Test of Skew Negative (no vertical misalignment) Positive (eyes at different heights; covered eye moves when uncovered)

INFARCT Mnemonic: Impulse Normal, Fast-phase Alternating, Refixation on cover Test = Central pattern = Consider stroke

Common Peripheral Vestibular Disorders

Disorder Duration Features Treatment
BPPV Seconds (<1 min); triggered by position Positional (rolling over, looking up); positive Dix-Hallpike; no hearing loss; latency; fatigable Epley maneuver
Vestibular neuritis Hours to days; continuous Acute continuous vertigo; positive head impulse test; no hearing loss; horizontal nystagmus Steroids; short-term suppressants; vestibular rehab
Labyrinthitis Hours to days; continuous Same as vestibular neuritis + hearing loss Same as vestibular neuritis + possible antivirals
Meniere's disease 20 min to hours; episodic Episodic vertigo + fluctuating hearing loss + tinnitus + aural fullness; low-frequency hearing loss on audiometry Low-sodium diet; diuretics; intratympanic therapy if refractory
Vestibular migraine Minutes to hours; episodic Associated with migraine features (headache before/during/after; photophobia; phonophobia); migraine history Migraine preventives; triptans for acute
Superior semicircular canal dehiscence Variable Sound-induced or pressure-induced vertigo (Tullio/Hennebert sign); autophony; conductive hyperacusis; dehiscence on CT Avoid triggers; surgical plugging if disabling

Red Flags for Central Cause ("DOs and DON'Ts")

Red Flag Concern
Diplopia, Dysarthria, Dysphagia Brainstem involvement
Other neuro signs (weakness, numbness, ataxia) Brainstem/cerebellar stroke
Normal head impulse test in acute vestibular syndrome Central lesion
Direction-changing nystagmus Central pattern
Vertical or purely torsional nystagmus Central pattern
Sudden severe headache or neck pain Vertebral artery dissection
Unable to walk (severe truncal ataxia) Cerebellar lesion
Skew deviation Brainstem lesion
Acute hearing loss without typical Meniere's features AICA stroke (involves labyrinth)

6. MONITORING PARAMETERS

ED / Acute Phase

Parameter Frequency Target Action if Abnormal
Neurologic exam (HINTS, cranial nerves, cerebellar) On presentation; q1-2h if central concern No focal deficits; peripheral pattern Central features → STAT MRI; neurology/stroke consultation
Vital signs q1h initially Stable BP, HR Orthostatic hypotension → fluids; arrhythmia → cardiology
Hydration status Continuous No dehydration IV fluids if dehydrated from vomiting
Nausea/vomiting control q1h Controlled Antiemetics; IV fluids
Gait assessment Before discharge Safe ambulation PT evaluation; fall precautions; walker if needed

Outpatient Follow-up

Parameter Frequency Target Action if Abnormal
Symptom resolution 1-2 weeks; then PRN Improving or resolved Persistent: repeat evaluation; vestibular rehab; subspecialty referral
Hearing (if applicable) Audiometry at 2-4 weeks Stable or improved Worsening: urgent ENT referral; MRI for schwannoma
Vestibular function Clinical; VNG if needed Compensation occurring Persistent hypofunction: intensify vestibular rehab
BPPV recurrence PRN No recurrence Repeat Epley; home exercises; canal switch (rare)
Migraine frequency (vestibular migraine) Monthly headache/vertigo diary Reduced frequency Adjust preventive therapy

7. DISPOSITION CRITERIA

Admission Criteria

Level of Care Criteria
ICU / Stroke unit Confirmed or highly suspected posterior circulation stroke; basilar artery occlusion; cerebellar stroke with mass effect/hydrocephalus
General floor Intractable vomiting/dehydration requiring IV fluids and monitoring; diagnostic uncertainty requiring observation and further testing; elderly with high fall risk and no safe home environment
Observation Prolonged symptoms requiring IV fluids and antiemetics; need for serial neurologic exams; MRI pending

Discharge Criteria

Criterion Details
Clear peripheral etiology BPPV (treated with Epley); vestibular neuritis/labyrinthitis (steroids started, symptoms manageable); Meniere's (acute episode resolved)
Central cause excluded HINTS peripheral pattern; OR MRI negative (with appropriate follow-up if early MRI); no focal neurologic deficits
Symptoms manageable Nausea/vomiting controlled; able to tolerate PO
Safe ambulation Can walk safely (with or without assistance); low fall risk; or adequate home support
Education provided Diagnosis explained; treatment plan; when to return (new neurologic symptoms, worsening vertigo, hearing loss)
Follow-up arranged PCP within 1 week; neurology/ENT if indicated; vestibular PT if indicated

Discharge Prescriptions

Medication Indication Instructions
Meclizine 25 mg PRN for breakthrough vertigo Take every 6-8h as needed; short-term use only; STOP after 48-72h
Ondansetron 4-8 mg ODT PRN for nausea Dissolve on tongue as needed for nausea
Prednisone (vestibular neuritis) Reduce vestibular inflammation 60 mg daily x 5 days then taper over 5 days (or per protocol)
Migraine preventive (vestibular migraine) Reduce migraine/vertigo attacks Per specific medication; titrate slowly
Diuretic (Meniere's) Reduce endolymph Per specific medication; monitor electrolytes

8. EVIDENCE & REFERENCES

Key Guidelines

Guideline Source Year Key Recommendation
BPPV Practice Guideline AAO-HNS 2017 Dix-Hallpike is gold standard for diagnosis; Epley maneuver is first-line treatment; vestibular suppressants NOT recommended
Vestibular Migraine Diagnostic Criteria ICHD-3 / Barany Society 2012/2018 Diagnostic criteria; often underdiagnosed; migraine preventives effective
Meniere's Disease Guidelines AAO-HNS 2020 Definite, probable, possible classification; conservative management first; intratympanic therapy for refractory
HINTS Exam Kattah et al. / Tarnutzer 2009/2011 HINTS more sensitive than early MRI for stroke in acute vestibular syndrome; requires training

Landmark Studies

Study Finding Impact
Kattah et al. (2009) HINTS exam (H: head impulse; I: nystagmus; TS: test of skew) was 100% sensitive and 96% specific for stroke in acute vestibular syndrome; superior to MRI in first 24-48h HINTS should be performed in acute vestibular syndrome; more sensitive than early MRI
Strupp et al. (2004) Methylprednisolone improved vestibular function recovery in vestibular neuritis vs. placebo Steroids are standard of care for vestibular neuritis
Hilton et al. Cochrane (2014) Epley maneuver highly effective for posterior canal BPPV; NNT ~3 Epley is definitive treatment for BPPV
Tarnutzer et al. (2011) Individual HINTS components analyzed; normal head impulse most predictive of stroke "Dangerous" HIT (normal in acute vertigo) = central cause until proven otherwise
Choi et al. (2018) 12-20% of posterior fossa strokes missed on early MRI (<48h) but detected on repeat MRI If high clinical suspicion for stroke and initial MRI negative, repeat MRI or treat as stroke
Fife et al. AAO-HNS (2017) Comprehensive BPPV guideline; repositioning maneuvers recommended; vestibular suppressants NOT recommended Standard of care for BPPV

HINTS Exam Validity

Study Sensitivity for Stroke Specificity
Kattah et al. (2009) 100% 96%
Newman-Toker et al. (2013) 96% 98%
Tarnutzer et al. (2011, meta-analysis) 98% (pooled) 85% (pooled)

Important: HINTS should ONLY be performed in the Acute Vestibular Syndrome (continuous vertigo/nystagmus lasting >24h). It is NOT valid for episodic vertigo (BPPV, Meniere's, vestibular migraine).


APPENDICES

Appendix A: HINTS Exam Protocol

Prerequisites: - Patient has ACUTE VESTIBULAR SYNDROME: Continuous vertigo >24h, nausea/vomiting, nystagmus, gait instability - Patient has SPONTANEOUS nystagmus visible at rest or with fixation removed - Examiner is trained in performing and interpreting HINTS

1. HEAD IMPULSE TEST (HIT) - Patient fixates on examiner's nose - Examiner holds patient's head and delivers small, rapid, unpredictable horizontal head turns (10-20°) - NORMAL (dangerous): Eyes stay on target without corrective saccade - ABNORMAL (reassuring): Corrective saccade back to target after head turn (eyes "catch up")

2. NYSTAGMUS EVALUATION - Observe spontaneous nystagmus in primary gaze - Then observe in right gaze and left gaze - PERIPHERAL (reassuring): Unidirectional — fast phase always beats the same direction regardless of gaze - CENTRAL (dangerous): Direction-changing — fast phase beats right on right gaze, left on left gaze; OR vertical; OR purely torsional

3. TEST OF SKEW (Alternate Cover Test) - Patient fixates on target - Cover one eye, then quickly move cover to other eye - Watch for vertical correction movement of uncovered eye - NEGATIVE (reassuring): No vertical movement - POSITIVE (dangerous): Vertical refixation (eye moves up or down when uncovered)

Interpretation: - ALL THREE peripheral pattern = Peripheral vestibular lesion (vestibular neuritis) - ANY ONE central pattern = Central lesion likely → Urgent MRI, stroke workup

Appendix B: Epley Maneuver Protocol (Right Posterior Canal BPPV)

For LEFT posterior canal BPPV, mirror all directions

  1. Starting position: Patient sitting on exam table, head turned 45° to the RIGHT
  2. Position 1: Rapidly lay patient back with head hanging over edge of table, still turned 45° right (Dix-Hallpike position); wait 30 seconds (or until nystagmus stops)
  3. Position 2: Rotate head 90° to the LEFT (now 45° left of midline); wait 30 seconds
  4. Position 3: Roll patient onto LEFT side, rotating head another 90° so nose points toward floor; wait 30 seconds
  5. Position 4: Slowly bring patient up to sitting position, keeping head turned left
  6. Finally: Turn head back to midline

Post-procedure: - May rest for a few minutes - Sleep with head elevated 45° for 1-2 nights (controversial but commonly recommended) - Avoid lying on affected side for 1 week - May need repeat maneuver if symptoms persist

Appendix C: Dix-Hallpike Maneuver Protocol

Purpose: Diagnose posterior canal BPPV

  1. Patient sitting on exam table
  2. Turn patient's head 45° toward the side being tested (e.g., RIGHT)
  3. While supporting head, rapidly lay patient backward with head hanging 20-30° below table edge
  4. Observe eyes for nystagmus

Positive result for RIGHT posterior canal BPPV: - Upbeating-torsional nystagmus (top of eye beats upward and toward the RIGHT ear) - Latency: 2-20 seconds before nystagmus appears - Duration: <60 seconds (typically 10-40 seconds) - Fatigable: decreases with repetition - Patient experiences vertigo

If positive: Proceed immediately to Epley maneuver

Caution: Modify technique for cervical spine disease (use side-lying Dix-Hallpike)

Appendix D: Vestibular Rehabilitation Exercises (Home Instructions)

GAZE STABILIZATION EXERCISES (for vestibular hypofunction)

Exercise 1 (VOR x 1): - Hold a business card at arm's length with a word or letter on it - Keep the card still and move your head side to side while keeping the word in focus - Start slowly, gradually increase speed - 1-2 minutes, 3-5 times daily

Exercise 2 (VOR x 2): - Move both the card and your head in opposite directions - Keep the word in focus - More challenging; progress when VOR x 1 is easy

BALANCE EXERCISES

Standing balance progression: 1. Feet together, eyes open → eyes closed 2. Semi-tandem stance (heel touching arch), eyes open → eyes closed 3. Tandem stance (heel to toe), eyes open → eyes closed 4. Single leg stance, eyes open → eyes closed

Hold each position 30-60 seconds; use wall for safety

BRANDT-DAROFF EXERCISES (for residual BPPV symptoms)

  1. Sit on edge of bed
  2. Quickly lie down on RIGHT side with head turned 45° upward; wait 30 seconds
  3. Return to sitting; wait 30 seconds
  4. Quickly lie down on LEFT side with head turned 45° upward; wait 30 seconds
  5. Return to sitting
  6. Repeat 10-20 times, 3 times daily

Appendix E: When to Use Each Test

Clinical Scenario Primary Test
Acute continuous vertigo + nystagmus (acute vestibular syndrome) HINTS exam
Episodic positional vertigo (triggered by rolling over, looking up) Dix-Hallpike maneuver
Episodic vertigo + hearing loss/tinnitus/aural fullness Audiometry; consider Meniere's
Episodic vertigo + headache/migraine features Headache diary; consider vestibular migraine
Presyncope / lightheadedness with standing Orthostatic vital signs; ECG; Holter
Chronic non-specific dizziness Full vestibular testing (VNG); consider PPPD; psychology eval

This template represents the initial build phase (Skill 1) and requires validation through the checker pipeline (Skills 2-6) before clinical deployment.