Approach to Acute Dizziness/Vertigo in the Emergency Department: Selected Controversies Regarding Specialty Consultation

Authors

Madeleine M. Puissant, Emergency Department, Maine Medical Center, Portland (M.M.P.).
Susan Giampalmo, Department of Emergency Medicine, Yale New Haven Hospital and Yale School of Medicine, CT (S.G., C.R.W.).
Charles R. Wira, Department of Emergency Medicine, Yale New Haven Hospital and Yale School of Medicine, CT (S.G., C.R.W.).
Joshua N. Goldstein, Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.N.G.).
David E. Newman-Toker, Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.N.-T.).

Document Type

Article

Publication Date

10-2024

Institution/Department

Emergency Medicine; Center for Interdisciplinary Population and Health Research

Journal Title

Stroke

Abstract

Acute dizziness and vertigo are common emergency department presentations (≈4% of annual visits) and sometimes, a life-threatening diagnosis like stroke is missed. Recent literature reviews the challenges in evaluation of these symptoms and offers guidelines for diagnostic approaches. Strong evidence indicates that when well-trained providers perform a high-quality bedside neurovestibular examination, accurate diagnosis of peripheral vestibular disorders and stroke increases. However, it is less clear who can and should be performing these assessments on a routine basis. This article offers a focused debate for and against routine specialty consultation for patients with acute dizziness or vertigo in the emergency department as well as a potential path forward utilizing new portable technologies to quantify eye movements.

Recommended Citation

Puissant MM, Giampalmo S, Wira CR 3rd, Goldstein JN, Newman-Toker DE. Approach to Acute Dizziness/Vertigo in the Emergency Department: Selected Controversies Regarding Specialty Consultation. Stroke. 2024;55(10):2584-2588. doi:10.1161/STROKEAHA.123.043406