Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Mar;49(3):788-795.
doi: 10.1161/STROKEAHA.117.016979. Epub 2018 Feb 19.

Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls

Ali S Saber Tehrani  1 , Jorge C Kattah  1 , Kevin A Kerber  1 , Daniel R Gold  1 , David S Zee  1 , Victor C Urrutia  1 , David E Newman-Toker  2
Affiliations
Review

Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls

Ali S Saber Tehrani et al. Stroke. 2018 Mar.
No abstract available

Keywords: diagnostic errors; dizziness; neuroimaging; neurologic examination; stroke; transient ischemic attack; vertigo.

PubMed Disclaimer

Conflict of interest statement

Conflict(s) of Interest/Disclosure(s):

Drs. Saber Tehrani, Gold, Zee, and Urrutia report no disclosures relevant to this manuscript.

Figures

Figure 1
Figure 1
Timing, triggers, and target examination (TiTrATE) approach to diagnosing dizziness and vertigo, highlighting cerebrovascular causes (red). Abbreviations: AED, antiepileptic drug; CO, carbon monoxide; EOM, extraocular movement; Hx, history; MI, myocardial infarction; PE, pulmonary embolus; PRN, pro re nata (as needed); VS, vital signs. Modified from, Neurol Clin. 33, Newman-Toker DE and Edlow JA, Titrate: A novel, evidence-based approach to diagnosing acute dizziness and vertigo, 577-599, viii 2015 with permission from Elsevier.
Figure 2
Figure 2
Suggested imaging strategy for stroke in patients with new (A) transient or (B) acute, continuous dizziness or vertigo. Abbreviations: BPPV, benign paroxysmal positional vertigo; CPPV, central paroxysmal positional vertigo; TIA, transient ischemic attack; MRI, magnetic resonance imaging; MRA, magnetic resonance angiography; Dx, diagnosis; CTA, computed tomography angiography; HINTS, head impulse, nystagmus, test of skew; ED, Emergency Department. Modified from Handb Clin Neurol. 136, Newman-Toker DE et al. Vertigo and hearing loss, 905-921, 2016 with permission from Elsevier.
See this image and copyright information in PMC

References

    1. Saber Tehrani AS, Coughlan D, Hsieh YH, Mantokoudis G, Korley FK, Kerber KA, et al. Rising annual costs of dizziness presentations to u.S. Emergency departments. Acad Emerg Med. 2013;20:689–696. - PubMed
    1. Newman-Toker DE, Edlow JA. Titrate: A novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin. 2015;33:577–599, viii. - PMC - PubMed
    1. Newman-Toker DE. Missed stroke in acute vertigo and dizziness: It is time for action, not debate. Ann Neurol. 2016;79:27–31. - PMC - PubMed
    1. Newman-Toker DE, McDonald KM, Meltzer DO. How much diagnostic safety can we afford, and how should we decide? A health economics perspective. BMJ quality & safety. 2013;22(Suppl 2):ii11–ii20. - PMC - PubMed
    1. Eagles D, Stiell IG, Clement CM, Brehaut J, Kelly AM, Mason S, et al. International survey of emergency physicians' priorities for clinical decision rules. Acad Emerg Med. 2008;15:177–182. - PubMed

Publication types