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Content Update: Hints, Vertigo, and Nystagmus April 2020

Text change under BEDSIDE TESTING FOR BPPV: Note that although it is appropriate to perform the Dix-Hallpike test on patients with short episodes of dizziness brought on by head movement, and without spontaneous or gaze evoked nystagmus, such patients should not have the HINTS-Plus exam performed on them. The latter would produce erroneous results. The HINTS-Plus exam should be reserved for patients with ongoing constant vertigo and spontaneous or gaze evoked nystagmus. See Figure 170-2.


Vertigo is defined as the sensation of self-motion when no motion is occurring. Vestibular disorders are conditions that affect the vestibular sensory organs in the inner ear or the cerebellum and brainstem and the connections between them.

Some patients have difficulty describing the sensation of vertigo. 1 Dizziness is a nonspecific word patients use to describe vertigo, but is also used by some patients to describe the symptoms of presyncope, imbalance, lightheadedness, and other sensations. Assess patients for nonvestibular causes of dizziness such as orthostatic hypotension, presyncope, and new medications such as antihypertensives.

Vertigo is a diagnostic challenge because it has many potential causes ( Table 170-1 ).

TABLE 170-1Peripheral and Central Causes of Vertigo

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