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  • Primary Care Guidelines Vertigo

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    Syahidatul Kautsar Najib
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    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. Key recommendations include exploring the characteristics of symptoms, examining for nystagmus, and performing a Hallpike test. The guidelines describe common causes of vertigo like BPPV and vestibular neuritis and their treatments. Referrals are recommended for red flag symptoms like persistent dizziness lasting over a month or unilateral hearing loss.

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    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. Key recommendations include exploring the characteristics of symptoms, examining for nystagmus, and performing a Hallpike test. The guidelines describe common causes of vertigo like BPPV and vestibular neuritis and their treatments. Referrals are recommended for red flag symptoms like persistent dizziness lasting over a month or unilateral hearing loss.

    Copyright:

    © All Rights Reserved
    Scarica in formato PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    119 visualizzazioni1 pagina

    Primary Care Guidelines Vertigo

    Caricato da

    Syahidatul Kautsar Najib
    This document provides guidelines for primary care physicians on evaluating and managing patients presenting with vertigo or dizziness. Key recommendations include exploring the characteristics of symptoms, examining for nystagmus, and performing a Hallpike test. The guidelines describe common causes of vertigo like BPPV and vestibular neuritis and their treatments. Referrals are recommended for red flag symptoms like persistent dizziness lasting over a month or unilateral hearing loss.

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    © All Rights Reserved
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    PrimaryCareGuidelinesVertigo/Dizziness

    Vertigoisdefinedasanillusionofmovement
    Explorecharacteristicsofsymptoms;examinefornystagmus
    DoaHallpiketestinallpatientspresentingwithvertigo/dizziness
    Ateverystage,exploreRedFlagsandreferasnecessary
    DizzinesswithpresyncopalsymptomsshouldbereferredtoCardiology RefertoENT/AVMif:
    Onlythecommoncausesofvertigoareincluded o Anyother
    Diagnosis:BPPV nystagmus
    ClickhereforHallpike RxEpley,if o Norecoveryafter2
    Patientattendswith positionaltestand nystagmus Epleys
    vertigo/dizziness Epleydemonstration consistentwith
    Posteriorcanal
    Vertigolasting< Hallpikepositive BPPV(up
    1minand beating ConsiderMeniresdiseaseif
    triggeredby rotational
    Hallpikenegative vertigolasts<24hours.
    changesinhead geotropic)(1)
    StartBetahistine16mgmg
    position tdsandrefertoENT/AVM
    Yes
    Isthevertigo Yes Recurrent
    associatedwith attacks?
    Vertigolasting unilateral Yes ConsiderLabyrinthitis(2)
    20minutesor hearing
    more loss/tinnitus?
    No Consider Startvestibularsuppressants
    VestibularNeuritis forupto72hourse.g
    (3) prochlorperazine510mgtds.
    RefertoENT/AVMifno
    betterafter4weeks
    EpisodicVertigo Consider
    Exploremigraine Vestibular
    lastingseconds Trydietaryavoidance.Ifno
    triggers/features migraine(4)
    tohours
    improvement,consider
    prophylaxis
    o Considermultisensoryfactorsinelderly egpizotifen0.5mg1.5mg
    Dizziness/
    (5) on.Ifnobetterrefer
    imbalance
    o Uncompensatedperipheralvestibular AVM/Neurology
    provokedby
    impairment(6)
    general
    o Bilateralvestibularfailure:oscillopsia(7)
    movement
    withheadmovement RefertoENT/AVMfor
    o Centralvestibular(seeRedFlags) aetiologyandmanagement

    1. Thenystagmusbeatsupwardstorwardstheceilingandistorsional REDFLAGS
    (rotational)totheundermostear(intheHallpikepostion).Seevideo o Firstattackofvertigowithacutesevereheadache
    link. Tobeadded (refertoA/Er/oCVA)
    2. Ifsuddenonsetofsignificantunilateralhearingloss:consider o Persistentsymptomsfor>1month(referto
    steroids60mgdailyfor6days.MRImayberequired.Bestoptionis ENT/AVM)
    samedayreferraltoENT. o Nystagmuslasting>48hours(refertoENT/AVM)
    3. Considervestibularmigraineifvestibularneuritisappearsrecurrent o Unilateraltinnitus/dyascusis/auralfullness(follow
    (morethan3episodes) tinnituspathway)
    4. Vestibularmigrainemaypresentwithoutheadaches.Maybe o Sudden/fluctuatinghearingloss(followhearing
    associatedwithbilateraltinnitus,auralfullnessandmuffledhearing. losspathway)
    CanmimicMeniresdisease.RefertoAVM/ENTifunsure. o Dysconjugateeyemovements(refertoNeurology)
    5. Iffallsareasignificantfeature,considertheFallsClinic/Careofthe o Posteriorcirculationsymptoms(referto
    Elderly. Neurology)
    6. Stopprochlorperazineandcinnarizine.Explorepsychologicalfactors o PositiveHallpikeTest,provokingnystagmusbutno
    inchronicallydizzypatients. symptoms(refertoAVM/Neurology)
    7. Oscillopsiaisthesensationthatviewedobjectsaremovingor o Verticalnystagmus(refertoAVM/Neurology)
    waveringbackandforth,whilstthepatient(especiallythepatient's o Cerebellarsigns(refertoNeurology)
    head)ismoving.
    Thesearepurposefullyveryshortguidelines.Formore
    References:Awaitingreferences comprehensiveinformationpleaseseeguidelineswrittenby
    Authors:DrVictorOseiLah,DrPeterWest,Mr.N.Saunders, DrPeterWest.Clickhere.
    Mr.S.Watts,MrJBuckland,DrDWhitehead
    OthersInvolved:CWSENTTask&FinishGroup,WSHTLRMG
    Datepublished:05/13Reviewdue:05/15

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