Abstract
Acute continuous vertigo presentations are among the most feared presentations in
medicine. Although a self-limited disorder is the typical cause, a life-threatening
stroke can also occur. Differentiating a self-limited disorder from a life-threatening
stroke can be a challenge. Routinely collected information—such as stroke risk factors
and findings on the general neurologic examination—is not likely to enable the clinician
to discriminate between these causes. A focused oculomotor examination is a necessary
component of the assessment, but is underused in routine care. The author describes
the challenges to diagnosing stroke in cases of acute continuous vertigo and provides
an approach to inform decision making at the bedside. Future research is necessary
to validate clinical decision support, assess generalizability, and demonstrate its
impact on meaningful outcomes.
Keywords
dizziness - vertigo - stroke - vestibular neuritis - clinical decision making
