PROPOSED GUIDELINE
for the
ED ASSESSMENT
Of
VERTIGO
(v1)
In this context, the purpose of the ED assessment is to rule out entities that are an immediate threat to the health of the patient. In the case of vertigo, the risk most often of concern is stroke. However, vertigo is common, and certainly not all cases justify an MRI. Even in consideration of an acoustic neuroma, the symptoms are unlikely to resolve over a few weeks, as usually happens with BPPV, and an MRI is not necessarily indicated through the ED. In the case of stroke, up to half of small brainstem lesions can be missed by MRI. The purpose of this guideline is to provide structure to the evaluation, and to decrease the probability of missing a cerebrovascular event while decreasing the frequency of unnecessary testing and hospitalization. It is not the purpose of this guideline, nor is it possible, to provide a diagnosis for all cases of dizziness.
For practicality, this guideline is in a format enhancing decision support. Like any decision tree, it is possible to get led astray by one mistaken entry, and the guideline should not override the judgment of the assessing physician.
Presently, this guideline is a draft version and not yet intended for actual patient decision making.
I will appreciate your comments and suggestions via email to .
Please include the word "vertigo" in your subject.
Thank you,
Paul Ash
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