Vertigo - part 1 - assessment in general practice.

BACKGROUND: Vertigo is a common and diagnostic challenge faced by clinicians. OBJECTIVE: This article discusses the assessment of patients with vertigo. DISCUSSION: The clinical assessment aims to: establish the presence of true vertigo, differentiate between vertigo of central or peripheral origins, and to evaluate the need for urgent investigations and referrals. Peripheral causes of vertigo are more common, but central causes such as transient ischaemic attack or stroke should always be considered and ruled out appropriately. Presence of syncope excludes the peripheral causes of vertigo. Vertigo in the elderly population is likely to be multifactorial and warrants careful evaluation. Online videos of the head impulse test and the Dix-Hallpike manoeuvre are valuable as these tests are of great diagnostic value. Audiological testing and neuroimaging can provide further information to guide patient management. (author abstract)