eMedicine Specialties > Emergency Medicine > Neurology

Central Vertigo: Follow-up

Author: Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Nov 6, 2009

Follow-up

Further Inpatient Care

  • Most patients with proven or suspected central vertigo should be admitted to the hospital for further evaluation and treatment.
  • Patients should be admitted under the care of a neurologist or neurosurgeon.
  • Patients with evidence of acute brainstem or cerebellar disease should be admitted to a monitored bed, preferably in an intensive care unit.

Transfer

  • Transfer may be necessary for patients seen in facilities lacking cranial imaging capability or neurosurgical coverage. Transferred patients require monitoring and the availability of definitive airway management during the transport period.

Deterrence/Prevention

  • The clinician should suspect TIAs in patients with recurrent transient symptoms and risk factors for atherosclerotic or cardioembolic disease. Prognostic scores for early risk of stroke after TIA may be helpful in assessing risk.17
  • A correct diagnosis of TIA followed by appropriate aspirin or anticoagulant therapy may decrease the risk of a future CVA significantly.

Prognosis

  • Prognosis for patients with central vertigo depends on the underlying disease and is highly variable.
  • Neurosurgical advancements have improved the prognosis for many serious conditions. This magnifies the importance of identifying these patients in the emergency setting.
  • The prognosis of infarction of the basilar or vertebral arteries is poor. In one series, 45% of patients presented in coma. Importantly, half of the patients in this series had prodromal symptoms, including vertigo, which cleared completely in the 6 months prior to the stroke.12
  • The prognosis for patients with spontaneous cerebellar hemorrhage is poor. Neurologic deterioration in these patients is associated independently with a hematoma in the central vermian area of the cerebellum and with secondary hydrocephalus.1

Patient Education

  • Most causes of central vertigo have serious ramifications. Inform the patient of the suspected diagnosis in understandable terms and explain the necessity of hospital admission.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Vertigo.

Miscellaneous

Medicolegal Pitfalls

  • Failure to have a low threshold for obtaining consultation, imaging, and further studies on patients who present with isolated vertigo and who have risk factors for atherosclerotic or other central disease
  • Failure to monitor patients closely for clinical deterioration who have disease involving or compromising the brain stem

Special Concerns

  • Geriatric patients are at particularly high risk for cerebrovascular disease and should be evaluated aggressively.
 


More on Central Vertigo

Overview: Central Vertigo
Differential Diagnoses & Workup: Central Vertigo
Treatment & Medication: Central Vertigo
Follow-up: Central Vertigo
Multimedia: Central Vertigo
References
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References

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Further Reading

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Keywords

central vertigo, vertigo, central vertigo causes, central vertigo treatment, central vertigo symptoms, acoustic neuroma, acoustic neurinoma, CNS tumor, CNS infection, peripheral ischemic vertigo, temporary vertebrobasilar ischemia, migraine syndrome, transient ischemic attacks, cerebellar infarction

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Contributor Information and Disclosures

Author

Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Medtronic Ownership interest None; Cambridge Heart, Inc. Ownership interest None

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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