Vertigo
Introduction
Vertigo is a false perception of motion (either of the patient or the environment) and is a common, diagnostically challenging emergency department (ED) presentation. Population prevalence is around 3-10% of adults; dizziness/vertigo account for a substantial proportion of acute presentations and up to ~12% of neurological ED visits.
Reported misdiagnosis rates are high (≈74-81%), reflecting overlapping causes, mimic conditions (presyncope, disequilibrium), and operator dependence of bedside vestibular testing.
The clinical priority in the ED is to distinguish peripheral vestibular disorders (usually benign) from central causes, particularly posterior‑circulation (cerebellar/brainstem) stroke, which may be time critical (see NICE NG127; NG128).
Definitions and clinical classification
- Vertigo is an illusory sense of motion (spinning, tilting) and indicates vestibular system dysfunction but is not a diagnosis in itself.
- Dizziness is an umbrella term and should be sub‑classified into:
- Vertigo - an illusion of movement.
- Presyncope - a feeling of impending faint.
- Disequilibrium - imbalance without a sense of head movement.
- Non‑specific or light‑headedness.
Vertigo itself is divided clinically into:
- Peripheral vertigo - inner ear or vestibular nerve pathology (for example, BPPV, vestibular neuritis, Ménière’s disease, labyrinthitis).
- Central vertigo - lesions of the vestibular nuclei, cerebellum, brainstem, or pathways to cortex (for example, stroke, tumour, demyelination, vestibular migraine).