ENTNeurology
Vertigo Workup
Distinguish peripheral (BPPV, vestibular neuritis, Ménière's) from central (stroke, MS); HINTS exam.
Source: ENT UK; NICE CKS
Step 1 of ~7
info
Differentiate Peripheral vs Central
Peripheral: severe spinning, nausea, hearing change, tinnitus, horizontal-rotatory nystagmus suppressed by fixation, normal neurology.
Central red flags: brainstem / cerebellar signs, vertical / pure direction-changing nystagmus, persistent without remission.
HINTS exam (acute spontaneous vertigo):
• Peripheral: abnormal head impulse + unidirectional horizontal nystagmus + no skew.
• Central: normal head impulse + direction-changing nystagmus + skew deviation → urgent stroke pathway.
More sensitive than MRI in first 48h for posterior circulation stroke.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Cinnarizine · Vestibular Suppressant — Vertigo
- Unfractionated Heparin (Peripheral/Central Line Flush) · Anticoagulant flush / catheter maintenance
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Oxycodone with naloxone · Strong opioid + peripheral opioid antagonist
- Betahistine · Histamine Analogue (Vestibular)
Pathways
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only. Always apply local guidelines and clinical judgement.