This article, adapted from the NB Medical version, is to help differentiate when acute vertigo symptoms might be due to an acute posterior circulation stroke as opposed to a peripheral cause such as vestibular neuritis.
Symptoms of an acute posterior stroke may include: visual changes, vertigo, dysarthria, dysphagia, nausea, drowsiness.
Diagnosis: The 3 steps HINTS examination is now recommended and is more accurate than early MRI scanning in these patients.
The tests below are all best explained via You Tube.
- Head impulse test (HIT)
- Test of Skew (cover testing)
|Diagnosis||Head Impulse||Nystagmus||Test of Skew|
At least one of:
|Normal. No lag either way||Direction changing – horizontal then vertical in eccentric vision||Skew deviation|
|ENT (peripheral vertigo)
Needs ALL of:
|Abnormal – WITH lag.||Nystagmus does not change direction||NO skew deviation.|
- If posterior stroke suspected then 300mg aspirin stat.
- Refer for immediate imaging.