Specific differentials listed in this clinical mind map relate to the patient presentation of vertigo. Most patients do not use the word vertigo when describing their symptom as a chief complaint. Instead, commonly used phrases include dizziness, head spinning, and light headedness. Although there may be overlap, differences between the three presentations are as follows:
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Lightheadedness – feeling of passing out / pre-syncope
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Lack of balance / balance problems – dizziness
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Head spinning – vertigo
Once a clinician has determined that the patient has a spinning sensation, probable diagnoses listed on the mind map should be considered. If the patient describes their symptoms such that these appear to be lightheadedness or dizziness, differentials (in other clinical mind maps) must be considered. To address urgent/emergent situations, a clinician must review vital signs, appearance, alertness and FAST. These features are similar to the features discussed in some of the other neurological presentations, such as weakness, sensory loss, and loss of consciousness. Corresponding life-threatening diagnoses associated with urgent/emergent situations are cerebellar stroke or any intracranial pathology which can cause central vertigo. In order to weigh and remove anchor bias, a clinician must ask high yield questions such as timing (duration, frequency) and triggers (onset). Additionally, the clinician must ask questions about hearing loss, tinnitus, headache, additional neurological symptoms and use. TiTrATE, which stands for timing, triggers and targeted exam, has been described in the literature as a procedure to arrive at the cause of vertigo. A physical exam with an emphasis on the nervous system plays an important role in the evaluation of vertigo. HINT has been described in the literature to differentiate between peripheral and central causes of vertigo. This differentiation is important because it guides clinicians to decide whether neuro imaging must be performed or not.
Pertinent labs and imaging may be helpful in certain situations. However, the final diagnosis can be reached in most cases of vertigo with the help of a comprehensive history and a physical exam. A helpful mnemonic to remember the differentials is think BMW camp for BMVV CAM2B.