PERIPHERAL vs CENTRAL
Most common cause of peripheral vertigo:
A. Stroke
B. Vestibular neuritis
C. BPPV
D. Ménière’s disease
C. BPPV
Vertigo lasting seconds, triggered by rolling in bed, no neuro signs.
Most likely diagnosis?
A. Vestibular neuritis
B. BPPV
C. Posterior circulation TIA
D. Ménière’s disease
B. BPPV
Which patient is appropriate for HINTS?
A. Episodic positional vertigo
B. Continuous vertigo, spontaneous nystagmus
C. Lightheadedness on standing
D. Dizziness resolved on arrival
B. Continuous vertigo, spontaneous nystagmus
Which feature LEAST helps differentiate peripheral from central?
A. Gait
B. Nystagmus pattern
C. Vomiting severity
D. Focal neurology
C. Vomiting severity
Continuous vertigo with no hearing loss suggests:
A. Labyrinthitis
B. Ménière’s disease
C. Vestibular neuritis
D. TIA
C. Vestibular neuritis
Vertigo lasting hours, spontaneous episodes, associated tinnitus and fluctuating hearing loss.
A. Vestibular neuritis
B. BPPV
C. Ménière’s disease
D. Vestibular migraine
C. Ménière’s disease
HINTS shows: normal head impulse, unidirectional nystagmus, no skew.
Best interpretation?
A. Peripheral cause excluded
B. Central cause excluded
C. Still concerning for central cause
D. Diagnostic of vestibular neuritis
C. Still concerning for central cause
Acute vertigo + neck pain after minor trauma suggests:
A. Vestibular neuritis
B. Labyrinthitis
C. Vertebral artery dissection
D. Ménière’s disease
C. Vertebral artery dissection
Which feature suggests a CENTRAL cause?
A. Severe vomiting
B. Horizontal nystagmus
C. Direction-changing nystagmus
D. Positional symptoms
C. Direction-changing nystagmus
Sudden onset continuous vertigo for 36 hours, no hearing loss, vomiting, abnormal head impulse.
A. Posterior circulation stroke
B. Vestibular neuritis
C. Labyrinthitis
D. Vestibular migraine
B. Vestibular neuritis
Which single HINTS component is MOST specific for central pathology?
A. Head impulse
B. Nystagmus
C. Test of skew
D. Vomiting severity
C. Test of skew
Vertigo + ipsilateral facial weakness + hyperacusis.
A. Stroke
B. Ramsay Hunt syndrome
C. Vestibular neuritis
D. BPPV
B. Ramsay Hunt syndrome
Which patient is MOST concerning?
A. Vomiting with vertigo
B. Loud tinnitus
C. Inability to walk unaided
D. Severe nausea
C. Inability to walk unaided
Recurrent vertigo episodes lasting minutes–hours, photophobia, headache history, normal exam between attacks.
A. Ménière’s disease
B. Vestibular neuritis
C. Vestibular migraine
D. TIA
C. Vestibular migraine
HINTS suggests peripheral, but patient cannot walk unaided.
Best action?
A. Discharge with reassurance
B. Treat as vestibular neuritis
C. CT head and discharge if normal
D. Escalate as possible stroke
D. Escalate as possible stroke
Which patient is MOST likely to have a stroke despite benign-appearing vertigo?
A. 30-year-old with vomiting
B. 45-year-old with tinnitus
C. 72-year-old with AF and inability to stand
D. 50-year-old with BPPV history
C. 72-year-old with AF and inability to stand
Most important diagnosis to exclude in acute vertigo:
A. Ménière’s disease
B. Vestibular migraine
C. Posterior circulation stroke
D. Labyrinthitis
C. Posterior circulation stroke
Brief vertigo + diplopia + dysarthria, fully resolved in ED.
A. BPPV
B. Vestibular migraine
C. Posterior circulation TIA
D. Ménière’s disease
C. Posterior circulation TIA
Which nystagmus is most concerning?
A. Horizontal unidirectional
B. Fatigable
C. Vertical
D. Torsional
C. Vertical
Normal CT head in acute vertigo means:
A. Stroke excluded
B. Peripheral cause confirmed
C. Nothing useful
D. Safe to discharge
C. Nothing useful