Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

Abstract

Distinguishing between serious (e.g., stroke) and benign (e.g., benign paroxysmal positional vertigo, BPPV) disorders remains challenging in emergency consultations for vertigo and dizziness (VD). A number of clues from patient history and clinical examination, including several diagnostic index tests have been reported recently. The objective of the present study was to analyze frequency and distribution patterns of specific vestibular and non-vestibular diagnoses in an interdisciplinary university emergency room (ER), including data on daytime and season of presentation. A retrospective chart analysis of all patients seen in a one-year period was performed. In the ER 4.23% of all patients presented with VD (818 out of 19,345). The most frequent-specific diagnoses were BPPV (19.9%), stroke/transient ischemic attack (12.5%), acute unilateral vestibulopathy/ vestibular neuritis (UVH; 8.3%), and functional VD (8.3%). Irrespective of the diagnosis, the majority of patients presented to the ER between 8 a.m. and 4 p.m. There are, however, seasonal differences. BPPV was most prevalent in December/ January and rare in September. UVH was most often seen in October/November; absolute and relative numbers were lowest in August. Finally, functional/psychogenic VD was common in summer and autumn with highest numbers in September/ October and lowest numbers in March. In summary, daytime of presentation did not distinguish between diagnoses as most patients presented during normal working hours. Seasonal presentation revealed interesting fluctuations. The UVH peak in autumn supports the viral origin of the condition (vestibular neuritis). The BPPV peak in winter might be related to reduced physical activity and low vitamin D. However, it is likely that multiple factors contribute to the fluctuations that have to be disentangled in further studies.

Monthly and seasonal variations in vestibular neuritis

“…[6,8,13] In addition, 1 recent study reported that incidence of acute unilateral vestibulopathy due to viral etiology, which included VN, peaked in autumn, not in spring and early summer, among patients in the emergency department. [15] In general, there was no significant monthly and seasonal variations in number of visits for VN in the present study. Although there was an increasing trend in incidence of VN in summer, it was not In addition, in our analyses of subgroups according to sex and age, there were no significant monthly and seasonal variations in number of visits for VN.…”

Nystagmus Parameters of Supine Roll Test Correlates With Prognosis After Repositioning Maneuver in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo

“…Our study shows HC-BPPV recurrence is not correlated with age, gender, seasons, and blood pressure status, which is consistent with some previous studies ( 21 – 23 ), while other studies presented conflicting results, including our previous study on PC-BPPV ( 16 ). The results also showed that the recurrence of BPPV was closely associated with the female gender.…”

An observation of the peer-assisted learning (PAL) method in the clinical teaching of vertigo/dizziness-related diseases for standardized residency training (SRT) students in China: a randomized, controlled, multicenter study

“…However, distinguishing between serious and benign disorders caused by VD remains challenging in emergency consultations, even for experienced doctors. Additionally, misdiagnosis may be fatal for patients, e.g., serious disorders caused by a posterior stroke [ 4 ]. Therefore, the challenges of making a fast and correct diagnosis remind us of the importance of the clinical teaching of VD-related diseases.…”