Central Vertigo Follow-up

Updated: Nov 26, 2018
  • Author: Keith A Marill, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Follow-up

Further Inpatient Care

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  • 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.

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Transfer

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  • 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.

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Deterrence/Prevention

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  • 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. [22, 23]

  • A correct diagnosis of TIA followed by appropriate aspirin or anticoagulant therapy may decrease the risk of a future CVA significantly.

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Prognosis

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  • 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. [16]

  • 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. [3]

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Patient Education

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  • 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 patient education resources, see the Brain and Nervous System Center. Also, see the patient education article Vertigo.

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